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EXECUTIVE SUMMARY EXECUTIVE SUMMARY 1Conclusions and policy implications 1Conclusions and policy implications

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E-mail: [email protected] Website: www.unodc.org/wdr2019 PREFACE

The findings of this year’s World Drug Report fill in same time clamping down on organized crime and and further complicate the global picture of drug trafficking. challenges, underscoring the need for broader inter- Opium production and cocaine manufacture remain national cooperation to advance balanced and at record levels. The amounts intercepted are also integrated health and criminal justice responses to higher than ever, with the amount of cocaine seized drug supply and demand. up 74 per cent over the past decade, compared with With improved research and more precise data from a 50 per cent rise in manufacture during the same India and Nigeria – both among the 10 most-pop- period. This suggests that law enforcement efforts ulous countries in the world – we see that there are have become more effective and that strengthened many more opioid users and people with drug use international cooperation may be helping to increase disorders than previously estimated. Globally, some interception rates. 35 million people, up from an earlier estimate of The World Drug Report 2019 also registers a decline 30.5 million, suffer from drug use disorders and in opiate trafficking from Afghanistan along the require treatment services. The death toll is also “northern” route through Central Asia to the Rus- higher: 585,000 people died as a result of drug use sian Federation. In 2008, some 10 per cent of the in 2017. morphine and heroin intercepted globally was seized Prevention and treatment continue to fall far short in countries along the northern route; by 2017 it of needs in many parts of the world. This is particu- had fallen to 1 per cent. This may be due in part to larly true in prisons, where those incarcerated are a shift in demand to synthetics in destination mar- especially vulnerable to drug use and face higher kets. The increased effectiveness of regional responses risks of HIV and hepatitis C transmission. This gap may also play a role. represents a major impediment to achieving the Sus- Countries in central Asia, with the support of the tainable Development Goals and fulfilling the United Nations Office on Drugs and Crime international community’s pledge to leave no one (UNODC), have committed considerable resources behind. to strengthening regional cooperation through inte- Synthetic opioids continue to pose a serious threat grated UNODC country, regional and global to health, with overdose deaths rising in North programmes, as well as through platforms such as America and trafficking in fentanyl and its analogues the Central Asian Regional Information and expanding in Europe and elsewhere. The opioid Coordination Centre, the Afghanistan–Kyrgyzstan– crisis that has featured in far fewer headlines but Tajikistan Initiative and the Triangular Initiative that requires equally urgent international attention and its Joint Planning Cell. More research is needed, is the non-medical use of the painkiller tramadol, including to identify lessons learned and best prac- particularly in Africa. The amount of tramadol tices that could inform further action. seized globally reached a record 125 tons in 2017; International cooperation has also succeeded in the limited data available indicate that the tramadol checking the growth in new psychoactive substances. being used for non-medical purposes in Africa is The Vienna-based Commission on Narcotic Drugs being illicitly manufactured in South Asia and traf- has acted swiftly in recent years to schedule the most ficked to the region, as well as to parts of the Middle harmful new psychoactive substances, and the East. UNODC early warning advisory has helped to keep The response to the misuse of tramadol illustrates the international community abreast of the difficulties faced by countries in balancing nec- developments. essary access for medical purposes while curbing Political will and adequate funding remain prereq- abuse – with limited resources and health-care sys- uisites for success. Efforts by Colombia to reduce tems that are already struggling to cope – and at the cocaine production following the 2016 peace deal

1 EXECUTIVE SUMMARY 2019

with the Revolutionary Armed Forces of Colombia UNODC supports countries in putting their com- REPORT (FARC) are a case in point. Alternative development mitments into action through the application of initiatives have enabled farmers in central areas of international standards on the prevention and treat-

DRUG the country previously under FARC control to aban- ment of drug use disorders and HIV, as well as don coca bush cultivation and join the licit economy. standards and norms on the administration of justice The result has been a drastic reduction in cocaine and the treatment of prisoners. We provide tailored WORLD production. However, in other areas previously con- technical assistance through our field offices and trolled by FARC, criminal groups have moved in to global programmes, and through toolkits and fill the vacuum and expand cultivation. Alternative research. development can succeed, but not without sustained I hope the World Drug Report 2019 will shed further attention and integration into broader development light on the world drug problem and inform inter- goals. national community responses. By working together The successes identified amid the many, formidable and focusing attention and resources, we can help problems that countries continue to face in grap- people get the services they need without discrimi- pling with drug supply and demand highlight that nation, promote security and bring criminals to international cooperation works. The challenge justice, safeguard health and achieve the Sustainable before us is to make this cooperation work for more Development Goals. people. International cooperation is based on agreed frameworks. Nearly every country in the world has reaffirmed its commitment to balanced, rights-based action based on the international drug control conventions. The most recent reaffirmation of that commitment is the Ministerial Declaration on Strengthening Our Actions at the National, Regional and International Levels to Accelerate the Imple- mentation of Our Joint Commitments to Address Yury Fedotov and Counter the World Drug Problem, adopted at Executive Director the ministerial segment of the sixty-second session United Nations Office on Drugs and Crime of the Commission on Narcotic Drugs.

2 CONTENTS

BOOKLET 1 EXECUTIVE SUMMARY, CONCLUSIONS AND POLICY IMPLICATIONS PREFACE...... 1 EXPLANATORY NOTES...... 5 EXECUTIVE SUMMARY...... 7 LATEST TRENDS �� 7 Improved data sharpen understanding of the extent of drug use globally...... 7 Cocaine production and seizures reach record highs...... 8 Methamphetamine use causes rising concern across several regions...... 9 Synthetic opioid markets boom despite associated adverse health consequences...... 10 Heroin still reaching the market despite declining opium production and rising seizures...... 11 Cannabis market undergoes transition amid changes in legal status in some countries...... 13 LAW ENFORCEMENT �� 14 Authorities make inroads into hard-to-reach drug markets...... 14 Hallucinogen trafficking is more geographically clustered than trafficking in other drug types...... 15 Complex global smuggling networks underpin heroin and cocaine markets...... 15 Relationship between licit production and illicit markets remains sometimes unclear...... 18 HEALTH CONSEQUENCES �� 19 The adverse health consequences associated with the use of drugs remain considerable...... 19 Patterns of drug use and treatment needs vary according to gender...... 20 Prisoners are vulnerable to drug use but underserved by treatment programmes...... 20 Help for those who need it...... 23 CONCLUSIONS AND POLICY IMPLICATIONS...... 23 Mitigate concentrations of high risk...... 24 The global paradox of too much and not enough...... 24 Law enforcement is an integral part of the solution...... 25 Cannabis markets need to be closely monitored...... 25 Evolving complexity highlights need for further research...... 26 ANNEX...... 29 GLOSSARY...... 51 REGIONAL GROUPINGS...... 53

BOOKLET 2 GLOBAL OVERVIEW OF DRUG DEMAND AND SUPPLY

BOOKLET 3 DEPRESSANTS

BOOKLET 4 STIMULANTS

BOOKLET 5 CANNABIS AND HALLUCINOGENS

3 Acknowledgements The World Drug Report 2019 was prepared by the Research and Trend Analysis Branch, Division for Policy Analysis and Public Affairs, United Nations Office on Drugs and Crime (UNODC), under the supervision of Jean-Luc Lemahieu, Director of the Division, and Angela Me, Chief of the Research and Trend Analysis Branch. General coordination and content overview Editing Chloé Carpentier Joseph Boyle Angela Me Jonathan Gibbons Analysis and drafting Graphic design and production Philip Davis Anja Korenblik Kamran Niaz Suzanne Kunnen Thomas Pietschmann Kristina Kuttnig Fabian Rettenbacher Data management and estimates production Enrico Bisogno Coordination Conor Crean Francesca Massanello Hernan Epstein Administrative support Virginia Macdonald (WHO) Iulia Lazar Riku Lehtovuori Sabrina Levissianos Andrea Oterová Umidjon Rakhmonberdiev Ali Saadeddin Tun Nay Soe Keith Sabin (UNAIDS) Irina Tsoy Fatma Usheva Lorenzo Vita

Review and comments The World Drug Report 2019 benefited from the expertise of and invaluable contributions from INCB and from UNODC colleagues in all divisions. The Research and Trend Analysis Branch acknowledges the important contribution from its colleagues in the Laboratory and Scientific Section and in the Programme Development and Management Unit. The Research and Trend Analysis Branch acknowledges the invaluable contributions and advice provided by the World Drug Report Scientific Advisory Committee: Jonathan Caulkins Afarin Rahimi-Movaghar Paul Griffiths Peter Reuter Marya Hynes Alison Ritter Vicknasingam B. Kasinather Francisco Thoumi Charles Parry The research and production of the joint UNODC/UNAIDS/WHO/World Bank estimates of the number of people who inject drugs were partly funded by the HIV/AIDS Section of the Drug Prevention and Health Branch of the Division for Operations of UNODC. EXPLANATORY NOTES

The boundaries and names shown and the designa- All analysis contained in the World Drug Report is tions used on maps do not imply official endorsement based on the official data submitted by Member or acceptance by the United Nations. A dotted line States to the UNODC through the annual report represents approximately the line of control in questionnaire unless indicated otherwise. Jammu and Kashmir agreed upon by India and Paki- The data on population used in the World Drug stan. The final status of Jammu and Kashmir has Report are taken from: World Population Prospects: not yet been agreed upon by the parties. Disputed The 2017 Revision (United Nations, Department of boundaries (China/India) are represented by cross- Economic and Social Affairs, Population hatch owing to the difficulty of showing sufficient Division). detail. References to dollars ($) are to United States dollars, The designations employed and the presentation of unless otherwise stated. the material in the World Drug Report do not imply the expression of any opinion whatsoever on the References to tons are to metric tons, unless other- part of the Secretariat of the United Nations con- wise stated. cerning the legal status of any country, territory, city The following abbreviations have been used in the or area, or of its authorities or concerning the delimi- present booklet: tation of its frontiers or boundaries. Countries and areas are referred to by the names CBD cannabidiol that were in official use at the time the relevant data DALYs disability-adjusted life years were collected. DMT dimethyltryptamine All references to Kosovo in the World Drug Report, FARC Revolutionary Armed Forces of if any, should be understood to be in compliance Colombia with Security Council resolution 1244 (1999). HIV human immunodeficiency virus Since there is some scientific and legal ambiguity about the distinctions between “drug use”, “drug LSD lysergic acid diethylamide misuse” and “drug abuse”, the neutral term “drug NPS new psychoactive substances use” is used in the World Drug Report. The term PCP phencyclidine “misuse” is used only to denote the non-medical use of prescription drugs. PWID people who inject drugs All uses of the word “drug” and the term “drug use” THC tetrahydrocannabinol in the World Drug Report refer to substances con- UNAIDS Joint United Nations Programme trolled under the international drug control on HIV and AIDS conventions, and their non-medical use. UNODC United Nations Office on Drugs and Crime

EXECUTIVE SUMMARY

New surveys in India and Nigeria alter LATEST TRENDS the picture of global drug use – the number of opioid users and the Improved data sharpen under- number of people suffering from drug standing of the extent of drug use disorders globally are much higher use globally than previously thought In 2017, some 53.4 million people worldwide had Number of people using drugs is 30 used opioids in the previous year, 56 per cent higher per cent higher than in 2009 than the estimate for 2016. Among those people, 29.2 million had used opiates such as heroin and In 2017, an estimated 271 million people, or 5.5 opium, 50 per cent higher than the 2016 estimate per cent of the global population aged 15–64, had of 19.4 million. used drugs in the previous year. While that figure is similar to the 2016 estimate, a longer-term view The higher estimates in 2017 are the result of reveals that the number of people who use drugs is improved knowledge of the extent of drug use from now 30 per cent higher than it was in 2009, when new surveys conducted in two highly populated 210 million had used drugs in the previous year. countries, namely India and Nigeria. In Asia, the number of past-year users of opioids is now thought Although that increase was in part due to a 10 per to be higher, at 29.5 million, than the previous esti- cent growth in the global population aged 15–64, mate of 13.6 million. In Africa, the survey data from data now show a higher prevalence of the use of Nigeria led to a revision of the number of past-year opioids in Africa, Asia, Europe and North America users of opioids to 6.1 million, compared with the and of the use of cannabis in North America, South previous estimate of 2.2 million. America and Asia. The most widely used drug worldwide continues to be cannabis, with an esti- Overall, North America continues to be the subre- mated 188 million people having used the drug in gion with the highest annual prevalence of opioid the previous year. The prevalence of cannabis use use, with 4.0 per cent of the population using opi- has remained broadly stable at the global level for a oids. The Near and Middle East and South-West decade, even with the rising trends in the Americas Asia is the subregion with the highest annual preva- and Asia. lence of opiate use (opium, morphine and heroin),

Hepatitis C and opioid use disorders are responsible for most of the deaths and disability attributed to the use of drugs

Hepa��s C 42 million years HIV/AIDS 585,000 Opioid use disorders of "healthy" deaths life lost Cocaine use disorders (2017) (2017) Amphetamine use diorders Cannabis use disorders Other drug use disorders Other causes

Sources: Institute for Health Metrics and Evaluation, “Global Burden of Disease Study 2017”, Global Health Data Exchange.

7 EXECUTIVE SUMMARY 2019

at 1.6 per cent of the population. However, in terms The Colombian Government’s 2016 peace deal with REPORT of numbers of users, 35 per cent of the global opioid the Revolutionary Armed Forces of Colombia users and almost half of all opiate users worldwide (FARC) has helped to drastically reduce cocaine

DRUG reside in South Asia. production in central areas of the country, where farmers in areas previously controlled by FARC have With the new information from India and Nigeria, abandoned cultivation. But in other areas previously

WORLD the number of people who are thought to suffer from controlled by FARC, criminal groups have moved drug use disorders is now estimated to be 35.3 mil- in to continue and expand coca bush cultivation. lion. This number is 15 per cent higher than the previous estimate of 30.5 million. The term “people A third dynamic in Colombia saw entirely new areas with drug use disorders” designates people whose given over to coca bush cultivation during 2016, drug use is harmful to the point where they may reflected in the production data for 2017. These experience drug dependence and/or require areas are often far away from major cities, making treatment. it difficult for the central authorities to provide incentives to farmers to stop cultivation. Also, a Cocaine production and reduction in eradication efforts might have fostered seizures reach record highs the idea that cultivation was relatively risk-free. Record seizures help to keep cocaine Cocaine production reaches record supply in check level amid transition in Colombia The global quantity of cocaine seized in 2017 Estimated global illicit manufacture of cocaine increased to 1,275 tons – the largest quantity ever reached an all-time high of 1,976 tons (estimated reported, and an increase on the previous year of 13 as 100 per cent pure) in 2017, an increase of 25 per per cent. While cocaine seizures have risen by 74 cent on the previous year. This was mainly driven per cent over the past decade, production has risen by increases in cocaine manufacture in Colombia, by 50 per cent. which produced an estimated 70 per cent of the world’s cocaine. Colombia experienced a 17 per cent Overall, the interceptions mean that the amount of expansion in the area under coca bush cultivation cocaine available for consumption has increased at in 2017, and a 31 per cent rise in the amount of a slower rate than has manufacture. This suggests cocaine produced, mainly due to a marked rise in that at the global level, law enforcement efforts and the productive areas under coca bush cultivation. international cooperation have likely become more

Global opium production and cocainea manufacture, 1998–2018

12,000 1,976 2,000 Opium

11,000 10,410 Cocaine 10,000

8,090 Trend opium 9,000 7,790 1,500 8,000 1,317 7,000 6,000 1,000 4,350 5,000 902 4,000 Tons Tons cocaine of Tons Tons opium of 3,000 500 2,000 1,000 0 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Sources: UNODC, Coca and opium surveys in various countries; responses to the annual report questionnaire; and United States of America, Department of State, International Narcotics Control Strategy Report, various years. a Expressed at a hypothetical manufacturing output level of 100 per cent pure cocaine; actual cocaine manufacturing output, unadjusted for purity, is significantly higher.

8 Latest trends 1

effective with the interception of a larger share of Reported seizures and trafficking routes of cocaine products than in the past. “captagon” tablets, 2013–2017 The bulk of cocaine seizures are in the Americas, which accounted for almost 90 per cent of the global total in 2017. Interception close to the source of WESTERN AND manufacture is significant; Colombia alone inter- CENTRAL EUROPE cepted 38 per cent of the global total in 2017. Cocaine use is on the rise in North America and Western and Central Europe

Annual average seizures An estimated 18.1 million people used cocaine in of “captagon” 2013-2017 (kg) ≥ 1,000 the past year, with the highest rates reported in 100 to <1,000 10 to <100 North America (2.1 per cent) and Oceania (1.6 per 1to <10 0.1 to <1 cent). North America had seen a decline in cocaine < 0.1 trafficking reported but no information use between 2006 and 2012, but there are now signs on amounts seized available No data* of an increase, as there are in Western and Central captagon shipments by land captagon maritime shipments Europe, Oceania and some South American coun- captagon shipments by air tries. In parts of Asia and West Africa, increasing Sources: UNODC, annual report questionnaire data; International Narcotics amounts of cocaine have been reported to be seized, Control Board (INCB); Heads of National Law Enforcement (HONLEA) reports; which suggests that cocaine use could potentially Bureau of International Narcotics and Law Enforcement Affairs, International increase, especially among affluent, urban dwellers Narcotics Control Strategy Reports; EMCDDA, Captagon: understanding today’s illicit market, EMCDDA Papers, October 2018; Republique Française, in subregions where use had previously been low. Ministère de L‘Action et des Comptes Publics, Douane et Droits Indirect, Premières saisies de captagon en France - 750 000 comprimés à Roissy, 30 Mai 2017. Methamphetamine use causes The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations.The final bound- rising concern across several ary between the Republic of Sudan and the Republic of South Sudan has not yet regions been determined. * Boundaries are not displayed for adjacent countries or territories with no South-East Asia emerges as the world’s available data. fastest-growing methamphetamine market Asia report methamphetamine as the main drug of concern in treatment. In countries in the subregion Quantities of methamphetamine seized in East and with recent data, annual prevalence of metham- South-East Asia rose more than eightfold between phetamine use ranges between 0.5 and 1.1 per cent, 2007 and 2017 to 82 tons – 45 per cent of global which is rather high compared with the global aver- seizures. Preliminary data for 2018 indicate a further age. There are also signs of an increase in crystalline steep increase to roughly 116 tons. The 2018 figures methamphetamine use in South-East Asia. suggest that Thailand may have overtaken China in terms of methamphetamine seized, particularly of Potential harm from methampheta- methamphetamine tablets. Some 745 million meth- mine use is on the rise in North amphetamine tablets were reported seized in East America and South-East Asia in 2018, 515 million of them North America is the subregion with the highest in Thailand. A geographical shift in the manufacture prevalence of the use of amphetamines (ampheta- and trafficking of methamphetamine has taken place mine and methamphetamine), at 2.1 per cent of the recently, from China to other countries in the population aged 15-64. While the non-medical use subregion. of pharmaceutical stimulants is more prevalent in Information on methamphetamine use in South- North America, a significant number of people also East Asia is sparse. Most countries in South-East use methamphetamine.

9 EXECUTIVE SUMMARY 2019

People using methamphetamine tend to be more deaths reported in 2016. Fentanyl or fentanyl ana- REPORT frequent and more intense users than those who logues were involved in 69 per cent of those deaths misuse pharmaceutical stimulants, and they face in 2017, compared with 50 per cent in 2016.

DRUG potentially more damaging consequences. For Trafficking in fentanyl and its instance, the number of overdose deaths attributed analogues rises and expands outside to the use of psychostimulants including metham- WORLD North America phetamine has risen considerably in the United States, from 1,300 cases in 2007 to more than North America is the principal market for fentanyls, 10,000 in 2017; this increase was led by the concur- but seizure data suggest that trafficking has expanded rent involvement of synthetic opioids (fentanyls) in worldwide. While just four countries reported fen- those deaths. tanyl seizures to UNODC in 2013, 12 countries did so in 2016 and 16 countries in 2017. Synthetic opioid markets boom Europe hosts a small but growing market for fenta- despite associated adverse nyls. Seizures or use have been reported in most health consequences European countries. In Western and Central Europe, seizures have risen from 1 kg in 2013 to 5 kg in North America’s synthetic opioid 2016 and 17 kg in 2017. The substances are often overdose crisis reached new heights sold on the Internet, sometimes as “legal” replace- in 2017 ments for controlled opioids. North America has seen a rising number of overdose Tramadol: the other opioid crisis in deaths resulting from the use of opioids. More than low- and middle-income countries 47,000 opioid overdose deaths were recorded in the United States in 2017, an increase of 13 per cent West and Central and North Africa are currently from the previous year. Those deaths were largely experiencing a crisis of another synthetic opioid: attributed to synthetic opioids such as fentanyl and tramadol, which has been used as a painkiller for its analogues, which were involved in nearly 50 per decades. Limited information on the supply of tram- cent more deaths than in 2016. In Canada, nearly adol for non-medical use points to tramadol being 4,000 opioid-related deaths were reported in 2017, (illicitly) manufactured in South Asia and trafficked a 33 per cent increase from the 3,000 overdose to African countries and parts of the Middle East.

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10 Latest trends 1

Global seizures of tramadol rose from less than 10 kg in 2010 to almost 9 tons in 2013 and reached a Non-medical use of tranquillizers record high of 125 tons in 2017. New data from (benzodiazepines) Nigeria suggest the problem is greater than previously thought. The national drug use survey conducted in 2017 shows that 4.7 per cent of the iaz od ep z i population aged 15–64 reported the non-medical n n e e

use of prescription opioids in the previous year, with s b tramadol being by far the most common opioid misused.

Rapidly growing numbers of synthetic opioid new psychoactive substances emerging on the market ranked as 1 of the top 3 The number of new psychoactive substances (NPS) commonly used substances that are synthetic opioids, mostly fentanyl analogues, by 40 countries reported on the market has been rising at an unprec- edented rate. It rose from just 1 substance in 2009 to 15 in 2015 and 46 in 2017, while the overall number of NPS present on the market stabilized at around 500 substances per year over the period 2015–2017. Synthetic opioids have become the second most important substance group, after stimulants, in terms of NPS reported for the first time. The group accounted for 29 per cent of the newly identified NPS in 2017. higher among Heroin still reaching the market women despite declining opium production and rising seizures Drought in Afghanistan causes decline in cultivation and production of opium in 2018

Afghanistan was again the country responsible for the vast majority of the world’s illicit opium poppy cultivation and opium production in 2018. The 263,000 ha under cultivation in Afghanistan in 2018 dwarfs cultivation in nearest rivals Myanmar (37,300 ha in 2018) and Mexico (30,600 ha in 2016/17). main substance within polydrug use patterns, Overall, the global area cultivated fell by some 17 especially among opioid per cent in 2018 to 346,000 ha, largely as a result users of a drought in Afghanistan. Also, opium prices in Afghanistan fell rapidly between 2016 and 2018, probably because of overproduction in previous

11 EXECUTIVE SUMMARY 2019

REPORT DRUG WORLD - for International and Law Enforce 20 June 2014; Bureau Narcotics R R R R ≤ 10 10 100 100 1000 1000 10000 10000 R A A R R UOD R 201 L E OLE 201 W O E D D W 201 OLE L E R 201 UOD R 201 L E T G 120 201 The boundaries and names shown the designations used on this map do not imply official endorsement or acceptance by Uni ted Nations. Dashed lines represent undetermined boundaries. dotted line represents approximately Line of Control in J ammu Kashmir agreed upon India Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. boundary between the Republic of Sudan and South has not yet been determined. A dispute exists Governments Argentina United Kingdom Great Britain and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas). previous years); World Health Organization, Expert Committee on Drug Dependence, Thirty-sixth Meeting, Geneva, 16 ‒ years); World previous (and previous years). years). International Narcotics Control Strategy Report 2019 (and previous ment Affairs, parties. The final boundary between the Republic of Sudan and South has not yet been determined. A dispute exists Governments Argentina United Kingdom of Great Britain and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas). Reported seizures, diversion and trafficking routes of tramadol (based on reported seizures), 2013–2017 reported seizures), routes of tramadol (based on diversion and trafficking Reported seizures, Sources: UNODC, annual report questionnaire data; International Narcotics Control Board, Report 2018 (and previous years); Heads of National Law Enforcement Agency report 2018 (and 2018 (and Agency report years); Heads of National Law Enforcement Report 2018 (and previous Board, data; International Control questionnaire Narcotics UNODC, annual report Sources: status of Jammu and Kashmir has not yet been agreed upon by the The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India Pakistan. final status has not yet been The boundaries and names shown the designations used on this map do not imply official endorsement or acceptance by Uni ted Nations. Dashed lines represent undetermined boundaries.

12 Latest trends 1

years, making the crop less lucrative for farmers. heroin seizures exceed those of morphine and However, the area under cultivation today is more opium. than 60 per cent larger than it was a decade ago and Some 86 per cent of all opiates seized in 2017 were the estimated cultivation area in Afghanistan in intercepted in Asia, the region that accounts for 2018 is the second largest estimate ever. more than 90 per cent of global illicit opium Global production of opium was even more affected production. than was cultivation by the drought in Afghanistan, Global interceptions of heroin have increased at a which produced 82 per cent of the world’s opium faster pace than production, suggesting a likely in 2018. After an upward trend over the last two increase in the efficiency of law enforcement efforts decades, global production fell by 25 per cent from and international cooperation. 2017 to 2018, to some 7,790 tons. Despite that drop, the amount of opium produced was the third Cannabis market undergoes largest amount since UNODC started to systemati- transition amid changes in legal cally monitor opium production in the 1990s. status in some countries Opiate seizures increase to record levels Interception of cannabis herb appears less of a priority in North America Quantities of opiates seized globally again reached despite continued existence of illicit an all-time high in 2017. Some 693 tons of opium market were seized, which was five per cent more than in the previous year. In addition, 103 tons of heroin The Americas continue to account for the largest were intercepted, 13 per cent more than in 2016, share of cannabis herb seizures. South America and 87 tons of morphine, a 33 per cent rise. Express- accounted for 38 per cent of the global total in 2017, ing these seizures in common heroin equivalents, and North America for 21 per cent. However, in

Diversification of cannabis products consumed in some juridictions that allow the non-medical use of cannabis

mainly cannabis flower cannabis flower THC ≤ 10% 20% THC

edibles and others up to 69% THC

two decades 2017

Based on Orens and others, "Market size and demand for marijuana in Colorado".

13 EXECUTIVE SUMMARY 2019

previous years, it had been North America leading the proportion of tested cannabis concentrates that REPORT the way. Seizures of cannabis in North America are contain over 75 per cent THC has increased fivefold in long-term decline – down 77 per cent from the in recent years. There is also an increase in Colorado

DRUG level in 2010. This is reflected in data on global sei- in the demand for non-flower products such as oil- zures, which are 20 per cent lower than in 2016. filled vaporizer cartridges, wax/shatter concentrates and infused edibles.

WORLD The decline in seizures in North America has been accompanied by a rise in the non-medical use of cannabis in a context in which measures legalizing the non-medical use of cannabis were implemented LAW ENFORCEMENT in some jurisdictions. Despite the aim of preventing criminals from gen- Authorities make inroads into erating profits from the illicit trade in cannabis, hard-to-reach drug markets residual illicit cannabis markets continue to exist in many of the states that have legalized the non-med- Control of “legal highs” helps to snuff ical use of the drug. This is especially evident in out emerging drug markets Colorado and the State of Washington, which were The NPS market is diverse and dynamic, with new among the first jurisdictions to allow such measures, substances being synthesized regularly and often sold in 2012. In California, the initial attempts to license as “legal highs” – as alternatives to, or mixed with, the sale of cannabis in 2018 resulted in prices that controlled substances. Despite this, very few NPS were higher than in the illicit market and thus failed have established a long-term niche for themselves. to entice users away from the illicit market. Some evidence suggests that legal changes aimed at Intensity of cannabis use has been controlling NPS may have discouraged their use increasing in the context of cannabis among the general population, although they have legalization established themselves among small subpopulation groups. There was a marked general decline in the While more people are using cannabis in North use of “bath salts” (mostly synthetic cathinones) America than they were a decade earlier, the increase among young people in the United States after the has been more pronounced in the regular (non-med- sale of such stimulants was outlawed in 2011. Also, ical) use of the drug. For instance, in the United in the United Kingdom, use of mephedrone, another States, the number of past-year users of cannabis cathinone, declined sharply in the years after it was rose by some 60 per cent between 2007 and 2017, placed under national control in 2010. while the number of daily or nearly daily users of Initial drops in drug sales on the cannabis more than doubled over the period. This darknet after AlphaBay take-down group of regular users accounts for the largest share of the cannabis consumed. In mid-2017, law enforcement agencies took down Cannabis products have diversified and AlphaBay, one of the world’s biggest markets for increased in potency since legalization drugs on the darknet. They also infiltrated another prominent marketplace, Hansa, and kept it running In Colorado, while the potency (tetrahydrocannabi- to gather data before shutting it down. More nol (THC) level) of cannabis flower has remained recently, extensive undercover operations led to the lower than that of cannabis concentrates (20 per take-down in April 2019 of Wall Street Market, at cent versus 69 per cent, in 2017), the potency of that time the world’s second largest darknet market both product types increased by about 20 per cent after Dream Market, which announced its shutdown over the period 2014–2017. for the end of the same month. The market for cannabis concentrates has also Some of those who bought drugs on the darknet evolved rapidly, with a wide range of products now changed their behaviour after the take-downs, with available, each with varying levels of THC, although 15 per cent of customers saying they used the

14 Law enforcement 1

The market authorities in Asia, mostly in East and South-East for NPS is in 78 newly Asia. However, ketamine trafficking appears to be a constant emerging spreading to other regions, including Europe, the state of flux NPS in 2017 Americas and Oceania. LSD and other hallucinogens are mostly intercepted in North America

Some 88 per cent of seizures of hallucinogens other than ketamine were carried out in the Americas over the period 2015–2017. These operations were 492 different mostly carried out by law enforcement authorities NPS on the in the United States. market in 2017 In terms of weight, the most frequently intercepted substance in this group at the global level was phencyclidine (PCP), also known by its street name “angel dust”, which accounted for 44 per cent of the total quantity of hallucinogens seized between 2011 and 2017. However, dimethyltryptamine (DMT) started to dominate global seizures of hal- 73 NPS lucinogens (excluding ketamine) in 2016 and 2017. not reported since 2014 darknet less frequently and 9 per cent saying they Complex global smuggling had completely stopped using the darknet as of Janu- networks underpin heroin and ary 2018. Online surveys point to a potential decline cocaine markets in the proportion of users purchasing drugs on the darknet in 2018, notably in North America, Oce- The Balkan route remains the world’s ania and Latin America. busiest heroin trafficking channel Hallucinogen trafficking is The world’s single largest heroin trafficking pathway continues to be the Balkan route, which sees drugs more geographically clustered smuggled from Afghanistan through the Islamic than trafficking in other drug Republic of Iran, Turkey and the Balkan countries types and on to various destinations in Western and Cen- tral Europe. Seizures made by countries along the East and South-East Asia continues Balkan route accounted for 47 per cent of global to provide the biggest markets for quantities of heroin and morphine seized outside ketamine Afghanistan in 2017. Ketamine, a substance not under international con- Other routes take heroin out of Afghanistan via trol, accounts for 87 per cent of the quantity of Pakistan to South Asia or Africa (the southern hallucinogens seized in the last five years – although route), or through Central Asia to markets in the a typical dose of ketamine is far larger than a typical Russian Federation (the northern route). However, dose of lysergic acid diethylamide (LSD). If calcu- those routes seem to be less important, and that lated in terms of doses rather than by weight, LSD importance is declining further, as in the case of the would account for 95 per cent of the hallucinogens northern route. For example, in 2008, 10 per cent seized in the past 20 years. of global heroin and morphine interceptions were Over the period 2013–2017, 96 per cent of all keta- made in countries along the northern route; by mine quantities seized worldwide were reported by 2017, this had fallen to 1 per cent.

15 EXECUTIVE SUMMARY 2019

REPORT NORTH AMERICA DRUG CEAIA WORLD ASIA EAST ASIA SUTEAST ASIA SUT ASIA CETRA A TRAS U AREA CAUCASIA MIE EAST EURE ARICA EASTER EASTER EURE ARICA SUTEAST SUTER

ARICA RTER EST A EURE ESTER CETRA ARICA A CETRA

SUT AMERICA CARIEA CETRA AMERICA MEXIC RT AMERICA L ASIA Pakistan SOUTH-EAST UOD * A darker shade indicates a larger amount of heroin being seized with the country as transit/destination. The size of the route is based on total amount seized that route, according to information trafficking routes pro vided by Member States in annual report questionnaire, individual drug seizures and other official documents, over 2013 2017 period. are determined basis of reported country of departure/transit and destination in these sources. As such, they need to be considered as broadly indicative existing trafficking routes while several secondary routes may not be reflected. Route arrows represent the direction of trafficking: origins indicate either area of departure or the one last provenance, end points arrows indicate either area consumption next des tination trafficking. Therefore, trafficking origin does not reflect country in which the substance was produced. The main countries mentioned as transit or destination were identified on the basis of both number times they ident ified by other Member States departure/transit seizures, and annual average amount that these seizures represent during 20132017 period. For more details on the criteria used, please see Methodology section of this document. The boundaries and names shown the designations used on this map do not imply official endorsement or acceptance by Uni ted Nations. dotted line represents approximately Line of Control in Jammu Kashmir agreed upon India Pakist an. final status has not yet been agreed upon by the parties. A dispute exists between overnments of Argentina and United Kingdom reat ritain Northern Ireland concerning sovereignty over Falkland Islands Malvinas. M M Main heroin trafficking routes as described by reported seizures, 2013–2017 reported seizures, routes as described by trafficking Main heroin one of next destination of trafficking. Therefore, the trafficking origin either the area of departure or one last provenance, end points arrows indicate consumption next destination trafficking. Therefore, trafficking origin does not reflect the country in which the substance was produced. to be considered as broadly indicative of existing trafficking routes while several secondary routes may not be reflected. Route arrows represent the direction of trafficking: origins indicate Sources: UNODC, responses to the annual report questionnaire and individual drug seizure database. and individual drug seizure questionnaire to the annual report UNODC, responses Sources: eria used, please see the Methodology section of this document. seizures, and the annual average amount that these seizures represent during period 2013–2017. For more details on crit eria used, please see Methodology section of this document. seizures and other official documents, over the period 2013–2017. The routes are determined on basis of reported country of departure/transit and destination in these sources. As such, they need of Control in Jammu and Kashmir agreed upon by India Pakistan. The final status has not yet been agree d the parties. ified by other Member States as departure/transit or destination of The main countries mentioned as transit or destination were identified on the basis of both number times they ident ified by other Member States departure/transit ted Nations.The dotted line represents approximately the Line The boundaries and names shown the designations used on this map do not imply official endorsement or acceptance by Uni ted Nations.The dotted line represents approximately Line vided by Member States in the annual report questionnaire, individual drug The size of the route is based on total amount seized that route, according to information trafficking routes pro vided by Member States in annual report questionnaire, individual drug *A darker shade indicates a larger amount of heroin being seized with the country as transit/destination.

16 Law enforcement 1

SOUTH ANDEAN AMERICA COUNTRIES

Low volume ow volume Low High ow volume ASIA OCEANIA an contre mentone a orce EAST AND an contre mentone a trant an contre mentone a etnaton an contre mentone a ot trant an etnaton or etnaton ot man contre of orcetrant

11 SOUTH-EAST orce orce * A darker shade indicates a larger amount of cocaine being seized with the country as transit/destination. The size of the route is based on total amount seized that route, according to information trafficking routes pro vided by Member States in annual report questionnaire, individual drug seizures and other official documents, over 2013 2017 period. are determined basis of reported country of departure/transit and destination in these sources. As such, they need to be considered as broadly indicative existing trafficking routes while several secondary routes may not be reflected. Route arrows represent the direction of trafficking: origins indicate either area of departure or the one last provenance, end points arrows indicate either area consumption next des tination trafficking. Therefore, trafficking origin does not reflect country in which the substance was produced. The main countries mentioned as transit or destination were identified on the basis of both number times they ident ified by other Member States departure/transit seizures, and annual average amount that these seizures represent during 20132017 period. For more details on the criteria used, please see Methodology section of this document. The boundaries and names shown the designations used on this map do not imply official endorsement or acceptance by Uni ted Nations. A dispute exists between overnments of Argentina United ingdom reat ritain Northern reland concerning sovereignty over Falkland slands Malvinas. Main cocaine trafficking routes as described by reported seizures, 2013–2017 reported seizures, routes as described by Main cocaine trafficking one of next destination of trafficking. Therefore, the trafficking origin either the area of departure or one last provenance, end points arrows indicate consumption next destination trafficking. Therefore, trafficking origin does not reflect the country in which the substance was produced. to be considered as broadly indicative of existing trafficking routes while several secondary routes may not be reflected. Route arrows represent the direction of trafficking: origins indicate eria used, please see the Methodology section of this document. seizures, and the annual average amount that these seizures represent during period 2013–2017. For more details on crit eria used, please see Methodology section of this document. seizures and other official documents, over the period 2013–2017. The routes are determined on basis of reported country of departure/transit and destination in these sources. As such, they need Sources: UNODC. The main countries mentioned as transit or destination were identified on the basis of both number times they ident ified by other Member States departure/transit The boundaries and names shown the designations used on this map do not imply official endorsement or acceptance by Uni ted Nations. vided by Member States in the annual report questionnaire, individual drug The size of the route is based on total amount seized that route, according to information trafficking routes pro vided by Member States in annual report questionnaire, individual drug * A darker shade indicates a larger amount of cocaine being seized with the country as transit/destination.

17 EXECUTIVE SUMMARY 2019

Most of the heroin trafficked in the In the case of fentanyl, for example, the bulk of the REPORT Americas originates within the region substance found on the illicit market comes from illicit manufacture, although some small diversions

DRUG The amount of heroin seized in the Americas has of fentanyl have been reported in the United States. shown a clear upward trend over the last decade. Most of this trafficking takes place within North The large market for tramadol for non-medical use in North Africa and the Near and Middle East also WORLD America, usually from Mexico to the United States, although the heroin found in Canada originates in seems to be supplied by tramadol specifically manu- Afghanistan. factured and trafficked for the illegal market, but information remains limited. Analysis of wholesale seizures of heroin in the United The illicit market for other pharmaceu- States has shown the increasing predominance of tical opioids is likely sourced from licit heroin originating in Mexico. Some 80 per cent of channels, although illicit manufacture the heroin samples analysed in 2016 came from also occurs Mexico. Cocaine trafficking has expanded into Outside North America, where the diversion of a global phenomenon since the 1980s pharmaceutical opioids such as codeine and oxyco- done from the licit to the illicit market is evident, Some 143 countries across all regions reported such diversions are not reported in large quantities. cocaine seizures over the period 2013–2017, up This could be the result of underreporting or the from 99 countries over the period 1983–1987. limited capacity of law enforcement authorities to detect diversions. Most of the cocaine trafficked from the Andean countries of South America is destined for the main There is a gap in knowledge about the supply chain consumer markets in North America and Western of codeine, a substance used non-medically in many and Central Europe. Seizures in North America have subregions. The fact that most seized codeine is lic- more than doubled in recent years, from 94 tons in itly manufactured and the lack of evidence of illicit 2013 to 238 tons in 2017. laboratories manufacturing codeine suggest that non-medical use of codeine is largely fuelled by the The second most important cocaine trafficking flow legal supply chain. worldwide is from the Andean countries to Western Europe. The quantity of cocaine seized in Western However, it is unclear how and at what stage the and Central Europe has also more than doubled in supply of codeine for medical use is diverted for the past five years, from 65 tons in 2013 to 141 tons non-medical use. There may be a combination of in 2017. scenarios: some codeine preparations may be easy to access through pharmacies or other types of out- lets, and some diversion may take place before the Relationship between licit drug reaches the retail market, resulting in the licit production and illicit markets supply being diverted to the illicit market. remains sometimes unclear Fentanyl and tramadol markets are likely underpinned by illicit supply Data that can help explain whether pharmaceutical opioids are diverted from the licit to the illicit market or are illicitly produced at source are limited, although the situation varies depending on the substance and region.

18 Health consequences 1

More than 11 million HEALTH CONSEQUENCES people inject drugs The adverse health consequences associated with the use of drugs remain considerable More than 11 million people worldwide inject drugs People who inject drugs (PWID) experience multiple negative health consequences. They are at an increased risk of fatal overdose and are disproportionately affected by blood-borne infectious diseases such as HIV and hepatitis C. The number of people who inject drugs worldwide stood at 11.3 million in 2017. A small number of countries account for a considerable proportion of the global number of PWID. Some 43 per cent of all PWID reside in just three 1.4 million people who inject drugs countries: China, the Russian Federation and the are living with HIV United States. 5.6 million are living with hepatitis C Patterns of HIV infection among 1.2 million are living with both people who inject drugs have wide hepatitis C and HIV regional variations Roughly one in eight people who inject drugs lives with HIV, amounting to 1.4 million people. hepatitis C. However, despite the opportunity UNAIDS estimates that injecting drug users are 22 afforded by these new medications in addressing the times more likely than the general population to be high burden of hepatitis C among PWID, progress infected with HIV. in scaling-up prevention and treatment services among PWID has been slow. The prevalence of HIV among PWID is the highest by far in South-West Asia and in Eastern and South- Deaths and years of “healthy” life lost Eastern Europe, with rates that are 2.3 and 1.8 times attributed to the use of drugs remain the global average, respectively. Those two subre- unacceptably high gions also have higher than average proportions of injecting drug users. Some 585,000 people are estimated to have died as a result of drug use in 2017. More than half of those Action to tackle hepatitis C epidemic among people who inject drugs has deaths were the result of untreated hepatitis C lead- been slow ing to liver cancer and cirrhosis; almost one third were attributed to drug use disorders. Most (two Hepatitis C is highly prevalent among PWID, with thirds) of the deaths attributed to drug use disorders almost one half of PWID, or some 5.6 million were related to opioid use. people, living with hepatitis C. Some 42 million years of “healthy” life were lost Highly effective treatment for hepatitis C has (premature deaths and years lived with disability) recently become available in the form of direct-act- as a result of drug use. They were also mostly attrib- ing antivirals, potentially transforming the uted to drug use disorders, especially from the use management and outlook for PWID living with of opioids.

19 EXECUTIVE SUMMARY 2019

The greatest burden of disease is seen in East and Numbers of countries implemen�ng REPORT South-East Asia, North America and South Asia, interven�ons in at least one prison reflecting the large numbers of opioid users and

DRUG PWID in those subregions. 56 Opioid-subs�tu�on therapy Treatment demand for cannabis use

WORLD disorders is increasing in most regions

All regions except Africa, where the proportion is higher than in other regions, have seen an increas- 11 Needle-syringe programmes ing proportion of people entering treatment for cannabis use disorders as the primary drug of concern. Opioids (predominantly heroin) remain the main drug type for which people receive treatment 10 Both in Europe (particularly in Eastern and South-Eastern Europe) and Asia. In Europe, an ageing cohort of opioid users, many of them in contact with drug In countries in South and Central America, the non- treatment services, remains a health concern. medical use of tranquillizers in the past year concerns Cocaine users increasingly seek more than 2 per cent of the general population, and treatment in Europe, most often for such use is higher among women than among men. polydrug use Similarly, 14 countries in Western and Central Europe reported on the non-medical use of tran- The number of people seeking treatment for the quillizers in 2017, and in all countries the rate was first time for cocaine use disorders has increased higher among women than among men. Also, in 8 over the past two years in European Union coun- of the 14 countries, the non-medical use of tran- tries. Three quarters of those who accessed specialized quillizers was more prevalent than the use of drug treatment services for the first time were cannabis. reported in just three countries: Italy, Spain and the United Kingdom. Substance use by women tends to progress to drug use disorders in a shorter time period than substance Among all cocaine users entering drug treatment in use by men. However, women may be afraid to seek the European Union, one third were seeking treat- treatment, in particular if they are pregnant and fear ment only for cocaine use disorders. The rest also legal issues and social stigma. If they are mothers or reported the use of secondary substances, especially caregivers, childcare arrangements can become an alcohol and cannabis. Many of the “crack” cocaine issue, for example. users entering treatment reported using heroin as a secondary drug. Prisoners are vulnerable to drug use but underserved by Patterns of drug use and treatment programmes treatment needs vary according to gender People with a history of drug use or drug use disorders form a substantial Women disproportionately affected by part of the prison population in some the non-medical use of tranquillizers countries and sedatives Drug use and drug use disorders are highly prevalent The non-medical use of sedatives and tranquillizers among people who are incarcerated. Based on stud- was reported in all regions in 2017. Women are ies from high-income countries, drug use disorders particularly affected by this kind of substance use. are more prevalent in female prisoners than in male

20 Health consequences 1

Use of drugs during incarceration

any drug cannabis heroin

amphetamines cocaine “ecstasy”

Never used At least once Recent (past-month)

prisoners; 51 per cent of women, compared with 30 more prevalent than the use of amphetamines, per cent of men, are estimated to have suffered from cocaine or “ecstasy”. drug use disorders during the year before their incar- People who inject drugs in prisons face an especially ceration – a far higher rate than among the general high risk of transmission of HIV and hepatitis C as population. the result of the high prevalence of HIV and hepa- Information from low- and middle-income countries titis C in prison populations in general, and because is sparse, but studies suggest that almost half of pris- of a lack of availability of sterile needles and syringes oners in those countries had a history of drug use in many prisons, which may prompt prisoners to prior to incarceration. While cannabis was the most share injecting equipment more often and among common drug used, roughly 1 in 10 had ever used more people. The highest prevalence of injecting opiates and another 1 in 10 had a history of inject- drug use while incarcerated is found in Asia and the ing drug use. Pacific, Eastern Europe and Central Asia, where approximately one in five people held in prisons had Drug use, including drug injecting, is injected drugs at least once while incarcerated. documented in many prisons High levels of HIV and hepatitis C About one in three people held in prisons worldwide among people who inject drugs in is estimated to have used drugs at least once while prisons in some countries incarcerated. One in five report current (past- month) drug use. Cannabis is the most popular While the prevalence of HIV and hepatitis C among drug, but the current (past-month) use of heroin is the general prison population is much higher than

21 EXECUTIVE SUMMARY 2019

among the general population in the community, the REPORT limited data available point to rates that are substan- tially higher among PWID in prisons (injected any

DRUG drug before or during incarceration) than among non-injecting prisoners.

WORLD A review of available studies found that PWID in prison had six times the prevalence of HIV and more than eight times the prevalence of hepatitis C compared with the non-injecting prison population.

Major gaps in the prevention and treatment services for infectious diseases in prison

Fifty-six countries reported that they provided opioid substitution therapy in at least one prison in 2017, while 46 countries reported not having such a treatment option in prison settings. Needle-syringe programmes are far less available in prison: 11 countries reported their availability in at least one prison, but such programmes were confirmed as absent in 83 countries. While the provision of both interventions in combination can be particularly effective in preventing the spread of HIV and hepatitis C, there were only 10 countries that provided such interventions in at least one prison, although both were not necessarily available in the same prisons. The high prevalence of hepatitis C and HIV in prison populations, especially among PWID, and the considerable adverse health consequences associated with these infectious diseases underscore the need for testing and access to treatment in prison settings. Fewer countries report the availability of testing and treatment, in at least one prison, for hepatitis C (42 countries had testing and 39 countries had treatment) than for HIV (78 countries had testing and 87 countries had treatment).

22 CONCLUSIONS AND POLICY IMPLICATIONS

Strengthened international cooperation and con- substance use through interventions proven to be certed support are needed to stop global drug effective and supported by international standards. challenges from endangering efforts to achieve Sus- Vulnerability to initiating and developing substance tainable Development Goal targets to ensure healthy use disorders is contingent on a number of protec- lives and promote peace and justice. Changing tive and risk factors related to an individual and global patterns of drug use, involving controlled aspects of their environment – parents, family, drugs (heroin, cocaine, amphetamines and canna- school and peers – as well as the influence of the bis), NPS and non-medical use of pharmaceutical physical and socioeconomic environment. Interven- drugs, have contributed to increasingly complex tions can be successful only if they strengthen challenges. Some 35 million people suffer from drug protective conditions while attenuating or prevent- use disorders and 11 million inject drugs, of whom ing factors that increase vulnerability, including by 1.4 million live with HIV and 5.6 million live with contributing to the overall positive engagement of hepatitis C. young people and their families, schools and Evidence on the adverse health consequences of drug communities. use suggests a higher burden of disease than what Understanding drug use as a complex, multifaceted had previously been estimated, with over half a mil- and relapsing chronic condition that requires con- lion deaths and 42 million years of “healthy” life tinuing care and interventions, drawing on many lost due to drug use. Illicit drug crop cultivation disciplines, can help to dispel the stigma associated and plant-based manufacture are at historically high with drug use. This can also support increased efforts levels. Despite a decline in 2017, the area under to: opium poppy cultivation and global opium produc- • tion remain at high levels, and coca bush cultivation Scale up scientific evidence-based interventions for the treatment of drug use disorders that are and the global manufacture of cocaine have also integrated within the health-care delivery system reached record levels. of each country, encompass universal access to An area where the international community has had services, are available and accessible in different a degree of success is in addressing NPS, evidenced settings to people in need, are based on principles by a decline in the number of NPS identified and of human rights and ethics, and address the varied reported for the first time to UNODC. NPS have needs of people with drug use disorders. not been taken up in the market to the extent feared • Scale up the provision of the comprehensive a few years ago, and the international community package of nine interventions for the prevention has reacted in a timely manner to assess the harms and treatment of hepatitis C, HIV and other in- caused by NPS and to schedule those that warranted fections among people who use or inject drugs, which is a package based on the principles of international control. equality, comprehensiveness, accessibility and sus- tainability and which encompasses universal access Help for those who need it to services. Public health responses continue to fall short. Effec- • Ensure that emergency room interventions for tive treatment interventions based on scientific acute drug intoxication and overdose cases in hos- evidence and in line with international human rights pitals and in community settings are available and obligations are not as available or accessible as they accessible to people who use drugs; for each fatal need to be, and national governments and the inter- overdose there are at least 20 cases of non-fatal national community need to step up interventions overdose. to address this gap. • Scale up overdose prevention interventions, especially in the case of opioids, by promoting Greater commitments and resources are needed, access to naloxone and the training of potential first and foremost to scale up the prevention of first responders in overdose management, and

23 EXECUTIVE SUMMARY 2019

set up such overdose prevention programmes in upon the wider society, especially in relation to infec- REPORT the many subregions where they do not yet ex- tious diseases and mental health conditions, as ist. Opioids contribute to a major proportion of almost all people in prison eventually return to their

DRUG disability-adjusted life years (DALYs) attributed to communities. Improving the health outcomes of drug use disorders. people in prisons, in turn, improves public health and reduces health inequalities among the general WORLD Mitigate concentrations of population. high risk The global paradox of too A central principle of the 2030 Agenda for Sustain- much and not enough able Development is to “ensure that no one is left behind” and to “reach the furthest behind first”. Pharmaceutical opioids are essential medicines for Among the population groups most affected by the the management of pain and other conditions. Yet drug problem are people held in prisons. This year, a large proportion of the global population contin- the World Drug Report provides in-depth analysis of ues to have minimal access to such medicines drug use and its adverse health consequences in because of legislative, regulatory, administrative and prison settings, which suggests that the risks associ- human resource impediments. The aim of the inter- ated with drug use disorders and mental health national drug control conventions has always been disorders, HIV, hepatitis C and tuberculosis are to ensure the availability of controlled substances higher than among the general population. The for medical and scientific purposes while preventing prevalence of infectious diseases such as HIV, hepa- their diversion and misuse. Applying the spirit of titis C and active tuberculosis are also the international drug conventions calls for the disproportionally higher among prison populations, removal of barriers that can limit the availability in particular among those who inject drugs in and accessibility of controlled drugs for their medi- prison. cal use. Legal and regulatory frameworks and clinical guidelines based on rational prescription practices One strategy to mitigate risks associated with drug can help increase accessibility to prescription drugs, use and its adverse health consequences is to pro- including pharmaceutical opioids, while reducing mote alternatives to incarceration, in line with the the risk of their diversion. international drug control conventions, by provid- ing people who use drugs and with drug use However, irrational prescription practices, unjusti- disorders who have come into contact with the crim- fied promotion and uncontrolled availability of inal justice system with the option of entering prescription drugs result in negative consequences voluntarily evidence-based drug treatment services and their non-medical use has become detrimental within the community. to public and individual health in many subregions worldwide. The non-medical use of prescription People held in prisons have the same right to health drugs, in particular of pharmaceutical opioids, poses and well-being as any other person. The Nelson a dilemma for both national and international con- Mandela Rules emphasize that health care for people trol mechanisms. in prison should be of the same standard as that available in the community, and that continuity of As the analysis in the present report shows, non- treatment and care should be ensured on admission, medical use of prescription drugs is a major transfer and release from prison. The provision of component of overall polydrug use patterns and of the comprehensive package of 15 evidence-based the adverse health consequences of drug use. People key interventions that are essential for effective pre- misuse prescription drugs to self-medicate, especially vention and treatment of HIV, hepatitis C and in the context of a weak health system; to intensify tuberculosis in prison settings must be a key com- the effects of the main substance used; to overcome ponent of health-care services for people who use the side effects of the main drug, or to alleviate the drugs in such closed settings. It is also important to adverse effects and severity of withdrawal consider that the health of people in prison impacts symptoms.

24 Conclusions and policy implications 1

More research is needed to improve understanding Effectively addressing the supply of drugs requires of the dynamics of non-medical use of prescription shifting the focus of law enforcement agencies from drugs to address their misuse effectively while guar- measuring success by quantities of drugs seized to anteeing the availability and accessibility of essential dismantling drug trafficking organizations and medicines. The challenge is to strike the correct bal- transnational organized criminal groups. This in ance between legitimate medical accessibility and turn requires increased sophistication, the develop- the risk of diversion of prescription drugs. A case in ment of a critical mass of basic knowledge and the point is tramadol, which is medically in high sharing of operational information among law demand yet, due to its limited regulation, a source enforcement authorities and specialized units in dif- of profit for criminal groups operating in Central, ferent jurisdictions. In addition, the business West and North Africa, the Near and Middle East structure of organized crime groups is changing, at and subregions in Asia. Tightening control of trama- times moving towards more loosely associated net- dol in countries where its supply originates and in works that are difficult to interdict, and thus there destination countries helps to counter the traffick- is a need to enhance training for law enforcement ing of such falsified medicines. This was the basis officials and investment in analysis to understand of the recent measures introduced in India to control these new dynamics and design effective counter- tramadol under the narcotics law and thus give law narcotic interventions. Such actions would benefit enforcement authorities official powers to deal with from effective coordination among national, regional the illicit manufacturing and smuggling of the sub- and international institutions. stance. However, such national efforts rely on international cooperation, based on the principle of the shared and common responsibility. Cannabis markets need to be closely monitored Law enforcement is an integral While it is too early to assess the ultimate impact of part of the solution the legislation allowing the non-medical use of cannabis in Canada, Uruguay and jurisdictions in the Where vulnerability exists, criminal opportunity United States of America, some early trends are exploits. Addressing both in a balanced and com- worthy of close monitoring. One stated aim of legal- prehensive manner through health-centred, ization was to prevent organized crime groups from rights-based criminal justice responses is essential. generating profits from cannabis; however, thriving The record levels of cocaine and opiate production in the last couple of years, together with a still illicit cannabis markets still exist in many of the expanding market for synthetic drugs such as illicitly states in the United States that allow the non-med- manufactured fentanyl and its analogues, require ical use of cannabis. This is particularly evident in intensified efforts by law enforcement authorities. the states of Colorado and Washington, which, in International cooperation remains a tool crucial to 2012, were among the first jurisdictions in the coun- successfully countering drug trafficking. For exam- try to adopt measures allowing the non-medical use ple, China introduced national legislation in May of cannabis. 2019 that scheduled most of the fentanyl analogues currently known worldwide. Another outcome of such legislation is that commercial companies are rapidly replacing artisanal Nevertheless, since drug traffickers can replace drugs producers of cannabis. With the market for non- lost at wholesale cost, drug seizures per se cannot medical use of cannabis expanding rapidly, profits be expected to disrupt drug markets unless they are are more likely to dictate and control the course of exceedingly large. If a seizure is associated with the the cannabis industry than are public health con- dismantling of an organization that had a substantial siderations. The marketing and availability of a wide share of market throughput capacity, a correlation range of cannabis products with a THC content far between seizures and price changes, as well as an higher than that seen a couple of decades ago in impact on the drug market, may be observed. states allowing non-medical use is a case in point.

25 EXECUTIVE SUMMARY 2019

It is also noteworthy that in the United States, every Evolving complexity highlights REPORT single state that has legalized non-medical use of need for further research cannabis first legalized it in a medical capacity; with

DRUG the exception of one state, ballots have been the The availability of new and reliable data in 2019 on main route to the acceptance, first of medical and the extent of drug use from two countries with large then of non-medical use. The ongoing policy debate populations, Nigeria and India, has improved WORLD and its coverage in the media appear to have regional and global estimates of drug use enor- impacted the risk perceptions of harm caused by mously. This new empirical evidence has led to an cannabis use, especially among young people. This increase in the estimated global number of opioid is illustrated by the marked increase in more frequent users: there are 50 per cent more than previously and heavy use of cannabis and, while frequent and thought. This has implications for global measures heavy users constitute only a small share of all annual to address adverse health consequences attributed cannabis users, they account for the vast majority to the use of opioids and scale up services to address of the consumption of cannabis products in the the global opioid crisis. It is also a reminder of the market. The scientific literature suggests that people continuing need to improve data and analysis in a using cannabis who progress to daily use have a context where perceptions often dominate public higher probability of developing cannabis use dis- debate. Global drug challenges are evolving and orders, while regular and heavy use of cannabis with complex, requiring an evolving and refined under- a high THC content has been identified as a risk standing to inform responses. This requires the factor for acute and chronic adverse health out- scaling-up of data collection, dissemination, analysis comes, including mental health problems and and research. This will enable national and interna- cannabis use disorders. tional stakeholders to assess the drug problem with precision, guide global policy discussions and drive The availability of cannabis with a comparatively the international cooperation agenda and direct sup- higher THC content has resulted in an increasing port where it is needed. number of people seeking treatment for cannabis use disorders in many subregions. In addition to The international data collection system needs to evidence-based prevention strategies that start at an be brought up to date in order to reflect the dynam- early age, there is a need to improve understanding, ics of both drug use and the supply of controlled especially among young people, of the negative substances. The monitoring of the modi operandi health consequences, both of early initiation and of drug traffickers and their trafficking routes needs the long-term heavy and frequent non-medical use to capture the dynamics and incentive systems inher- of cannabis. ent to drug trafficking. There is a need to understand, in particular, the complexity and variability of the Moreover, public debate tends to confuse or conflate spectrum of drug trafficking modalities. The dynam- non-medical use of cannabis, including use of can- ics of the recent opioid crisis in North America, nabis flower and other concentrates with high levels which are now coming to light, highlight the need of THC, with medical use of cannabis products such to address both sophisticated trafficking of large as THC and CBD, often in the form of pharma- shipments in containers and the smuggling of small ceutical preparations for treating and managing packages containing NPS and synthetic opioids (fen- health conditions including chronic pain, multiple tanyl analogues) via the postal system. Some end sclerosis and spasticity symptoms, and sleep distur- users buy their products directly online or via the bances associated with fibromyalgia and chronic darknet, posing additional challenges. This chang- pain. CBD, a cannabinoid that is not a psychoactive ing landscape is a far cry from the situation of just agent and is often promoted as a health and well- two decades ago, with mostly organic psychoactive ness product, should not be confused with THC, a substances being trafficked across borders. very different and psychoactive cannabinoid. Policy, legislation and public debate would do well to Another illustration of how today’s dynamics address these very different issues with greater demand new insight is the decline in the trafficking clarity. of opiates along the northern route at a time when

26 Conclusions and policy implications 1

Afghan opiate production is at its peak. The decline Improving the quality and coverage of data on indi- in the quantities of opiates seized along the northern cators of drug use and its health consequences route can be attributed to altering trade incentives (especially estimates from highly populated coun- and risks, resulting in a possible displacement to tries) as well as supply indicators will strengthen the other routes. Among the potential reasons to be analysis and evidence presented in the World Drug studied are the decline in demand for opiates along Report and better inform the global policy debate. the northern route and the shift from the use of This requires promoting cooperation among differ- opiates to the use of other drugs, including synthetic ent international and regional stakeholders on data opioids, regional cooperation and the increasing collection, reporting and research. It also requires ability of national authorities to prevent opiate promoting initiatives for building capacities in trafficking. Member States to improve the quality and coverage of national data and conduct operational research To ensure better control of the illicit manufacture on drug markets. and trafficking of synthetic opioids (fentanyl and analogues) and other NPS, there is also a need to further develop national monitoring and research capacity not only to enhance forensic capacity but also to identify and report on the emergence of psychoactive substances. The evolving situation related to the non-medical use of cannabis and the expanding cannabis market has spurred understanding of the need for more research and consistent data. In the jurisdictions with legislation allowing the non-medical use of cannabis, the different cannabis products, their potency, health effects and use, including for medical purposes, are not yet fully documented, making it difficult for policymakers, pharmaceutical companies and potential users to assess the public health impact.

ANNEX ------0.64 0.70 0.66 2.27 0.25 1.00 0.82 0.12 0.70 0.92 0.52 0.22 0.46 0.28 0.40 Upper ------0.50 0.63 0.55 1.08 0.14 0.80 0.63 0.05 0.50 0.55 0.29 0.18 0.08 0.14 0.08 Lower ------

0.54 0.66 0.59 1.26 1.62 0.20 0.90 0.72 0.08 0.59 0.74 0.40 0.18 0.25 0.16 0.21 Best estimate Prevalence (percentage) Prevalence ------41 70 580 330 660 Opiates 2,030 1,570 3,600 6,910 4,010 2,970 3,480 2,800 Upper 24,570 34,520 ------35 40 470 150 120 530 1,590 1,410 3,010 3,300 2,330 1,790 1,970 Lower 18,970 24,510 ------

35 40 520 240 360 Number (thousands) 1,740 1,490 3,220 4,930 3,280 2,400 2,690 1,470 Best 12,990 21,730 29,160 estimate ------0.63 0.80 0.70 2.81 0.25 1.03 1.06 0.76 1.22 4.24 2.43 3.58 0.46 2.79 1.06 Upper ------0.52 0.74 0.61 1.61 0.15 0.83 0.88 0.09 0.96 3.60 1.79 2.98 0.08 2.18 0.71 Lower ------

0.58 0.77 0.66 1.81 2.28 0.20 0.93 0.98 0.20 1.08 3.96 2.03 3.28 0.25 2.48 0.87

Best estimate Prevalence (percentage) Prevalence ------600 680 660 730 Opioids 2,020 1,810 3,830 8,550 4,010 2,180 7,390 Upper 31,910 60,180 13,720 16,320 ------480 250 570 120 570 1,670 1,660 3,330 4,910 2,330 5,000 Lower 26,280 47,160 11,640 11,980 ------

540 580 630 360 650 (opiates and pharmaceutical opioids) Number (thousands) 1,840 1,730 3,570 6,950 3,280 6,080 Best 18,680 29,460 53,350 12,830 13,600 estimate - - - - - 7.5 2.8 5.6 2.9 3.7 1.4 4.2 2.2 3.6 4.4 3.3 7.2 8.7 9.0 13.8 23.1 11.0 11.0 11.3 Upper - - - - - 7.3 2.5 5.3 2.9 2.3 0.3 1.1 1.4 3.4 3.3 2.7 2.0 8.3 9.6 5.1 13.7 11.3 11.0 10.7 Lower - - - - -

7.4 2.6 5.4 2.9 3.1 0.8 2.9 1.8 3.5 3.8 2.9 3.6 8.4 6.4 13.8 17.2 10.0 11.0 10.9 Best estimate Prevalence (percentage) Prevalence - - - - - 80 990 6,220 2,410 2,090 2,090 2,950 Upper 23,990 30,210 29,520 11,180 21,740 64,840 10,440 44,810 29,420 58,330 62,690 Cannabis 219,020 - - - - - 40 640 820 580 2,790 5,530 6,890 4,160 9,740 2,090 23,270 28,810 Lower 29,430 41,140 44,460 25,700 55,600 35,350 163,680 - - - - -

60 880 Number (thousands) 2,840 5,880 9,500 1,670 1,040 2,090 Best 23,610 29,490 29,470 13,570 54,210 10,040 44,630 26,760 56,590 44,900 188,040 estimate

Region or subregion Western and Western and Central Europe Eastern and South-Eastern Europe South Asia South-West Asia/ South-West Near and Middle East East and South-East East and South-East Asia Central Asia and Central Asia and Transcaucasia South America Polynesia North America Caribbean Central America Melanesia Micronesia Southern Africa West and and West Central Africa Australia and Australia and New Zealand East Africa North Africa Oceania Europe Asia GLOBAL ESTIMATE Americas Africa Source: UNODC estimates based on annual report questionnaire data and other official sources. data and other official questionnaire UNODC estimates based on annual report Source: Annual prevalence of the use of cannabis, opioids and opiates, by region and globally, 2017 and globally, of the use cannabis, opioids and opiates, by region Annual prevalence

29 EXECUTIVE SUMMARY 2019 ------1.72 2.23 0.33 0.78 1.13 0.36 0.89 0.71 0.19 0.54 0.95 0.93 0.92 REPORT Upper ------1.56 2.12 0.07 0.16 0.01 0.10 0.89 0.05 0.16 0.51 0.06 0.39 0.84 DRUG Lower ------

1.68 2.17 0.17 0.41 0.26 0.23 0.89 0.38 0.18 0.52 0.31 0.54 0.86 Best Prevalence (percentage) Prevalence WORLD estimate ------450 430 100 100 550 “Ecstasy” 7,880 2,870 3,630 4,040 6,970 2,930 Upper 40,310 21,380 ------20 30 410 400 100 470 250 8,420 2,870 1,600 3,390 2,930 2,680 Lower ------

50 60 440 410 510 Number (thousands) 2,870 1,800 3,500 4,060 1,310 2,750 Best 21,290 11,490 estimate ------1.38 1.34 0.31 3.10 2.42 2.38 0.87 0.94 0.42 0.26 0.78 1.38 0.18 0.64 0.46 0.76 Upper ------1.24 1.34 0.09 0.56 0.05 1.85 0.31 0.13 0.23 0.22 0.17 0.99 0.18 0.43 0.18 0.61

Lower ------

and and b 1.34 1.34 0.21 1.58 0.87 2.11 0.59 0.53 0.34 0.25 0.47 1.17 0.18 0.53 0.32 0.68 Best Prevalence (percentage) Prevalence estimate ------11 360 250 100 700 610 740 7,690 6,600 9,230 1,850 3,480 1,040 2,440 Upper 42,960 23,290 ------2 30 20 Amphetamines 320 250 900 340 630 410 5,990 6,660 4,980 1,850 2,350 1,940 pharmaceutical stimulants Lower 15,210 ------5

60 350 250 500 250 710 710 Number (thousands) 6,840 3,680 7,860 1,850 2,900 2,180 Best 28,920 14,140 estimate ------and “ecstasy”, by region and globally, 2017 and globally, and “ecstasy”, by region b 1.67 2.23 1.02 2.15 0.42 0.24 1.15 1.04 0.37 1.58 0.07 0.04 0.10 0.95 0.32 1.39 Upper ------1.57 2.15 0.34 2.06 0.31 0.00 0.29 0.82 0.02 1.37 0.04 0.01 0.10 0.82 0.15 1.29 Lower ------

1.65 2.20 0.66 2.10 0.37 0.09 0.62 0.95 0.19 1.48 0.06 0.02 0.10 0.87 0.22 1.33 a Best Prevalence (percentage) Prevalence estimate amphetamines a ------420 310 633 330 130 720 440 Cocaine 6,950 3,000 2,570 2,220 1,030 5,140 4,420 Upper 20,960 10,590 ------1 80 30 410 100 160 340 410 6,660 2,360 1,140 9,200 1,030 4,460 4,120 Lower 15,380 ------

70 420 200 250 180 500 430 Number (thousands) 6,800 2,740 1,670 1,300 9,930 1,030 4,740 4,240 Best 18,070 estimate

Region or subregion Australia and Australia and New Zealand Melanesia North America Micronesia Polynesia East Africa Central America South America Central Asia and Central Asia and Transcaucasia North Africa Southern Africa East and South-East Asia West and Central Africa West Caribbean South-West Asia/Near Asia/Near South-West and Middle East South Asia Western and Western and Central Europe Eastern and South-Eastern Europe Amphetamines include both amphetamine and methamphetamine. Cocaine includes cocaine salt, "crack" cocaine and other types such as coca paste, cocaine base, "basuco", "paco" and "merla". Cocaine includes cocaine salt, "crack" and other types such as coca paste, base, "basuco", "paco" "merla". GLOBAL ESTIMATE Asia Africa Americas Europe Oceania b a Source: UNODC estimates based on annual report questionnaire data and other official sources. data and other official questionnaire UNODC estimates based on annual report Source: Annual prevalence of the use cocaine, Annual prevalence

30 Annex - PWID/HIV 1 100% 100% 100% 75.2% 98.0% 93.6% 98.7% 75.4% 93.9% 99.9% 73.0% 55.6% 99.9% 99.9% 95.7% number of number of inject drugs people who people who of estimated of estimated Data coverage Data coverage 8.5 7.5 7.3 6.9 1.2 3.8 12.3 10.0 28.9 11.4 10.6 10.0 19.6 23.5 12.7 estimate (%) Best (%) Best Prevalence Prevalence 1,700 44,000 10,400 High 100,000 925,000 482,000 284,000 515,000 259,000 159,000 126,000 105,000 556,000 431,000 2,260,000 1,600 3,200 50,000 34,000 93,000 82,000 93,000 Best 667,000 216,000 320,000 124,000 174,000 423,000 505,000 1,440,000 Estimated number HIV among people who inject drugs 1,300 1,800 16,000 28,000 42,000 94,000 67,000 84,000 Low 449,000 154,000 181,000 109,000 416,000 483,000 1,090,000 100% 100% 100% 73.2% 95.0% 93.6% 95.1% 57.8% 86.1% 83.0% 73.0% 87.9% 39.0% 99.9% 90.0% Data years population population aged 15-64 aged 15-64 coverage of coverage of 0.25 0.23 0.91 0.26 0.48 0.31 0.43 0.62 0.35 0.54 0.30 0.25 0.09 0.55 0.84 High 0.17 0.18 0.78 0.20 0.38 0.12 0.35 0.55 0.24 0.52 0.23 0.08 0.09 0.48 0.82 Best Prevalence (%) Prevalence 0.09 0.14 0.69 0.14 0.29 0.06 0.28 0.48 0.19 0.51 0.18 0.03 0.09 0.44 0.80 Low 850,000 530,000 950,000 140,000 270,000 950,000 High 6,900,000 4,200,000 2,140,000 2,020,000 2,870,000 1,130,000 1,860,000 2,990,000 15,030,000 People who inject drugs 90,000 Best 580,000 450,000 750,000 810,000 770,000 130,000 930,000 5,430,000 3,210,000 1,790,000 2,370,000 1,800,000 2,570,000 11,320,000 Estimated number 40,000 Low 300,000 400,000 570,000 450,000 590,000 130,000 910,000 4,130,000 2,210,000 1,560,000 1,860,000 8,930,000 1,760,000 2,350,000

Region or subregion Latin America Latin America Central Asia and Transcaucasia and the Caribbean Near and Middle East East and East and South-East Asia Asia South-West North America Western and Western and Central Europe South Asia Eastern and South-Eastern Europe Asia Africa America Oceania Global Europe former Reference Group to the United Nations on HIV and Injecting Drug Use; published peer-reviewed articles; and government reports. to the United Nations on HIV and Injecting Drug Use; published peer-reviewed Group former Reference Note: Prevalence of people who inject drugs is the percentage population aged 15–64 years. Estimated number and prevalence (percentage) of people who inject drugs and those living with HIV among this group, by region, 2017 by region, of people who inject drugs and those living with HIV among this group, (percentage) Estimated number and prevalence Source: Responses to the annual report questionnaire; progress reports of the Joint United Nations Programme on HIV/AIDS (UNAIDS) on the global AIDS response (various years); the (various years); the on HIV/AIDS (UNAIDS) the global AIDS response of the Joint United Nations Programme reports progress questionnaire; Responses to the annual report Source:

31 EXECUTIVE SUMMARY 2019 c ...... REPORT 29,700 29,700 47,200 47,200 242,000 283,000 37,300 263,000 2018 DRUG .. 282 38,400 22,800 30,200 30,200 51,900 51,900 41,000 30,600 301,000 355,000 328,000 2017 WORLD .. .. 462 30,000 20,400 25,200 182,000 221,000 201,000 2016 c 595 3,900 7,600 5,700 30,400 21,800 42,800 69,600 26,100 163,000 202,000 55,500 183,000 2015 c 387 3,500 9,000 6,200 41,400 87,300 17,000 196,000 247,000 57,600 224,000 2014 298 1,900 5,800 3,900 45,710 69,918 57,800 11,000 173,000 238,000 209,000 2013 313 3,100 6,800 38,249 64,357 11,500 51,000 10,500 125,000 189,000 154,000 2012 338 2,500 6,000 4,100 29,700 59,600 43,600 12,000 109,000 155,000 131,000 2011 341 1,900 4,000 3,000 17,300 58,100 38,100 14,000 104,000 145,000 123,000 2010 356 1,100 2,700 1,900 20,500 42,800 31,700 19,500 102,000 137,000 123,000 2009 710 394 2,700 1,600 17,900 37,000 28,500 15,000 157,000 2008 715 1,230 1,860 1,500 6,900 22,500 32,600 27,700 193,000 2007

b b a a a a a a

a a

b, d, f, h lower bound lower bound lower bound upper bound upper bound upper bound Afghanistan (best estimate) Lao People’s Democratic Republic (best estimate) Colombia (best estimate) upper bound Myanmar Myanmar (best estimate) lower bound Mexico (best Mexico (best estimate) SOUTH-WEST ASIA SOUTH-EAST ASIA SOUTH AND CENTRAL AMERICA Opium/heroin 2007–2018 (hectares) Illicit cultivation of opium poppy,

32 Annex - Opium/heroin 1 g g g 45,471 345,771 2018 307,751 385,551 345,800 14,589 367,251 462,251 414,500 414,471 2017 2018". 68,139 256,501 335,601 294,800 294,801 2016 10,597 242,692 320,792 281,500 281,492 2015 11,522 269,809 372,209 316,700 316,709 2014 13,293 245,201 338,309 295,300 295,291 2013 respectively. 2017 July 12,282 189,444 287,952 234,900 234,895 2012 16,462 170,000 249,400 207,500 207,500 2011 June 2016 and ‒ 12,221 149,762 233,662 190,700 190,662 2010 9,479 June 2015. June 152,935 211,835 185,900 185,935 2009 10,509 213,000 213,003 2008 5,885 235,700 235,700 2007 e

lower bound upper bound OTHER tion of opium poppy, 2008 ‒ poppy) but no direct measurement. See table "Cultivation of opium poppy and production in other countries, eradica tion poppy, are included in this category. as they are not part of its official figures and it does have information on the methodology used to calculate them. detailed description of the estimation methodology is available in the online methodology section of the World Drug Report 2019. detailed description of the estimation methodology is available in online section World

public, Myanmar for 2016 and Mexico and Colombia for 2018) In addition, for 2016, 2017 and 2018, best estimates countries which data are not available (Lao People's Democratic Re public, Myanmar 2016 Mexico Colombia 2018) A Starting in 2008, a new methodology was introduced to estimate opium poppy cultivation and opium/heroin production countries with no data on illicit of poppy. Drug Report 2016 (United Nations publication, Sales No. E.16.XI.7), have been revised owing to a statistical adjustment processed by UNODC. The figures for 2015, as published in the World The figures for 2016 and 2017 are based on the estimation periods July 2015 ‒ Preliminary estimates for 2018; they may change as more country estimates will become available. es not validate the estimates provided by the United States Up to 2014, the estimates for Mexico are sourced from Department of State United States. The Government do es not validate provided by States ntries with indirect evidence of illicit cultivation (eradication of opium Includes countries with low levels of cultivation (with less than 400 hectares in at least two the last three years) and cou ntries indirect evidence illicit (eradication opium These figures are based on the estimation period July 2014 ‒ May include areas that were eradicated after the date of the area survey. May include areas that were eradicated after the date of area survey.

Bound of the statistically derived confidence interval.

Estimates for 2014, 2015 and 2018 included satellite image estimates Kayah Chin states. National these y ears are therefore not directly comparable with the other years. TOTAL TOTAL (best estimate, rounded) Other countries TOTAL (best estimate) TOTAL

b h f g a c d e Note: Figures in italics are preliminary and may be revised when updated information becomes available. Two dots indicate that data were unavailable. Information on estimation methodologies dots indicate that data were unavailable. Information on estimation methodologies Note: Figures in italics are preliminary and may be revised when updated information becomes available. Two Colombia: Government surveys by the Government strategy of Colombia. Mexico: up to 2014, estimates derived from of the United States America (international control narcotics entitled "Monitoring of the illicit cultivation on Mexican territory". joint Mexico/UNODC project for 2015 and onwards, reports);

and definitions can be found in the online methodology section of the World Drug Report 2019. and definitions can be found in the online methodology section of World Sources: Afghanistan, Lao People's Democratic Republic and Myanmar: national illicit crop monitoring system supported by the United Nations Office on Drugs and Crime (UNODC). on Drugs and Crime (UNODC). monitoring system supported by the United Nations Office Afghanistan, Lao People's Democratic Republic and Myanmar: national illicit crop Sources:

33 EXECUTIVE SUMMARY 2019 ...... 410 664 520 870 REPORT 5,600 7,200 6,400 2018 DRUG 7 .. 292 395 876 706 550 272 586 8,000 9,000 10,000 2017 WORLD .. .. 13 261 684 888 482 4,000 5,600 4,800 2016 .. 84 17 279 693 176 500 820 647 178 499 2,700 3,900 3,300 2015 h 51 92 12 133 481 916 198 360 670 5,100 7,800 6,400 2014 11 35 23 11 182 225 870 630 630 4,500 6,500 1,100 1,100 5,500 2013 8 18 69 41 172 220 690 520 520 870 870 2,800 4,200 3,700 2012 8 15 36 25 290 250 420 420 830 830 610 610 4,800 6,800 5,800 2011 8 11 24 18 224 300 580 350 350 820 820 3,000 4,200 3,600 2010 7 9 16 11 178 425 330 213 213 445 445 4,000 2009 4 16 10 10 187 325 410 5,900 2008 7 9 11 58 14 150 460 7,400 2007

b, f b, f b c, e d g a a g

lower bound lower bound lower bound lower bound upper bound upper bound upper bound upper bound (best estimate) Afghanistan Afghanistan (best estimate) Lao People’s Democratic Republic (best estimate) Colombia (best estimate) Other countries Myanmar Myanmar (best estimate) Mexico Mexico (best estimate) SOUTH-WEST ASIA SOUTH-EAST ASIA AMERICA LATIN OTHER Potential production of oven–dry opium, 2007–2018 (tons) Potential production

34 Annex - Opium/heroin 1 -

6,540 9,070 7,790 7,790 7,790

2018 8,920 11,907 10,415 10,410 10,410 2017 2003. The opium production 2003. The opium production 4,973 7,391 6,184 6,180 6,180 2016 2014. 3,758 5,784 4,771 4,770 4,770 2015 6,202 9,419 7,732 7,730 7,730 2014 2017 are based on: (a) the area under cultivation, established by 2017 are based on: (a) the area under cultivation, established by 5,558 8,052 6,810 6,810 6,810 2013 3,738 5,539 4,831 4,830 4,830 2012 2018". 2018". 5,783 8,214 6,983 6,980 6,980 2011 3,894 5,576 4,730 4,730 4,730 2010 4,953 4,950 4,950 2009 6,841 6,840 6,840 2008 8,091 8,090 8,090 2007

lower bound upper bound ing of the illicit cultivation on Mexican territory" become available. Opium production figures estimated by UNODC for 2015 ‒ opium poppy and production of opium in other countries, and eradication of opium poppy, 2008 ‒ of opium in other countries, and eradication poppy, opium poppy and production figures shown for 2015-2017 are preliminary and, for methodological reasons, are not comparable with the production figures over period 1998 ‒ World Drug Report 2019. World not part of its official figures and it does have information on the methodology used to calculate them. are included in this category. methodology is available in the online methodology section of the estimates are higher than the previous figures but have a similar order of magnitude. A detailed description estimation methodology is available in online section the joint project of Government Mexico and UNODC; (b) yield data, based on studies conducted by United States in over period 2001 ‒ the calculation of global total. public, Myanmar for 2016 and Mexico and Colombia for 2018) In addition, for 2016, 2017 and 2018, best estimates countries which data are not available (Lao People's Democratic Re public, Myanmar 2016 Mexico Colombia 2018) These Starting in 2008, a new methodology was introduced to estimate opium poppy cultivation and opium/heroin production countries with no data on illicit of poppy. Owing to the late timing of monitoring activities in 2013, survey may not have captured illicit cultivation in this year its entirety. Bound of the statistically derived confidence interval, with the exception of 2015. The figures for 2015 represent independently derived upper and lower estimates; midpoint was used Estimates for 2014, 2015 and 2018 include estimates Kayah Chin states. National these years are therefore not directly comparable with the other years. The Government of Mexico does not validate any opium production estimates. figures will be presented once yield data from the joint Mexico/UNODC project entitled "Monitor Based on cultivation figures which may include areas eradicated after the date of area survey.

See table "Cultivation of Includes countries with low levels of cultivation and indirect evidence illicit (eradication opium poppy) but no direct measurement. See table "Cultivation Bound of the statistically derived confidence interval. The figures for 2015, as published in the World Drug Report 2016 (United Nations publication, Sales No. E.16.XI.7), have been revised owing to a statistical adjustment processed by UNODC. Drug Report 2016 (United Nations publication, Sales No. E.16.XI.7), have been revised owing to a statistical adjustment processed by UNODC. The figures for 2015, as published in the World idate the estimates provided by the United States as they are Up to 2014, the estimates are sourced from Department of State United States. The Government Mexico does not val idate provided by States as they TOTAL TOTAL (best estimate) best estimate TOTAL (rounded)

b h f a g c d e Note: Figures in italics are preliminary and may be revised when updated information becomes available. Two dots indicate that data were unavailable. Information on estimation methodologies dots indicate that data were unavailable. Information on estimation methodologies Note: Figures in italics are preliminary and may be revised when updated information becomes available. Two Colombia: National illicit crop monitoring system supported by UNODC. Since 2008, production was calculated based on updated regional yield figures and conversion ratios from and conversion ratios from yield figures was calculated based on updated regional monitoring system supported by UNODC. Since 2008, production Colombia: National illicit crop the Department of State and the Drug Enforcement Administration of the United States of America. Mexico: up to 2014, estimates derived from surveys by the United States surveys by the United States Administration of the United States America. Mexico: up to 2014, estimates derived from the Department of State and Drug Enforcement

Government; for 2015 and onwards, UNODC estimate. Government; UNODC estimate. for 2015 and onwards, and definitions can be found in the online methodology section of the World Drug Report 2019. and definitions can be found in the online methodology section of World Sources: Afghanistan, Lao People's Democratic Republic and Myanmar: national illicit crop monitoring system supported by the United Nations Office on Drugs and Crime (UNODC). on Drugs and Crime (UNODC). monitoring system supported by the United Nations Office Afghanistan, Lao People's Democratic Republic and Myanmar: national illicit crop Sources:

35 EXECUTIVE SUMMARY 2019 406 REPORT 2018 DRUG 2 90 15 0.2 264 750 700 49,154 2017 WORLD 3 6 37 60 0.2 106 355 399 130 310 0.05 0.05 2016 9 6 372 260 0.13 0.13 3,760 2015 5 14 284 217 640 0.45 1.41 1.41 0.18 0.18 7,470 2,692 2014 4 6 34 12 265 493 310 0.40 2.07 2.07 272.1 2,721 7,348 2013 3 9 4 204 209 382 220 0.21 20.4 1.91 1.91 2,628 9,672 2012 6 9 22 34 201 340 289 362 2.26 4.60 4.60 3,810 2011 8 5 87 43 868 289 2,316 1,721 2010 3 44 962 211 5,351 1,779 13.83 13.83 2009 5 48 288 8.76 8.76 5,480 1,909 7,761 7,761 2008 tor (tons) (tons) (tons) (plants) (plants) (hectares) (hectares) (hectares) (hectares) (hectares) (hectares) Indica - Production Production Production Production Production Production Cultivation Cultivation Cultivation Cultivation Cultivation Cultivation Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication equivalents) equivalents) equivalents) equivalents) equivalents) plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Country Azerbaijan Azerbaijan Bangladesh Austria Austria Australia Australia Armenia Argentina Algeria Algeria Afghanistan Thailand Thailand Pakistan Pakistan Guatemala Guatemala Cultivation of opium poppy and production of opium in other countries, and eradication of opium poppy, 2008–2018 of opium in other countries, and eradication poppy, Cultivation of opium poppy and production

36 Annex - Opium/heroin 1 2018 44 60 803 397 119 157 279,074 2017 9 6 45 92 94 624 105 450 85.9 2016 1,207,147 6 98 40 430 145 613 183,573 2015 8 51 144 813 1,197 2014 2,023,385 3 60 7.3 81 514 2,568 75,765 75,765 2013 1,797,966 26 590 192 320 185,490 185,490 2012 2,170,900 1 7 52 9.3 59 294 1,490 2,210 2,210 22,100 60,000 2011 7 14 918 222 712 6,600 60,000 12,865 12,865 128,653 2010 98 546 1,345 11,558 11,558 115,580 145,021 145,021 2009 121 536 381 7,456 7,456 74,555 2008

tor (plants) (plants) (plants) (hectares) (hectares) (hectares) (hectares) (hectares) (hectares) Indica - Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication equivalents) equivalents) equivalents) equivalents) equivalents) equivalents) equivalents) plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg Seizure poppy poppy Seizure poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Country Greece Egypt Guatemala Ecuador Georgia Ecuador Czechia Cyprus China Canada Canada Canada Colombia Belarus Belarus Bangladesh

37 EXECUTIVE SUMMARY 2019 REPORT 2018 DRUG 0.5 0.5 3,076 90,000 2017 WORLD 417,004,278 1 0.2 1917 2,875 1,098 1,098 15,515 90,000 2016 17,643,447 43 55 30 809 298 298 3,461 19,510 2015 9 8 1 63 168 168 2,254 1,636 3,770 3,770 120,000 864,150 864,150 2014 7 2 1 11 397 865 147 147 375 375 2,152 2,152 100,000 2013 10,935,532 10,935,532 1 12 30 20 707 399 399 716 716 6,717 1,332 1,502 1,502 140,000 2012 1 90 26 662 200 200 1,692 2,007 5,746 2011 2 58 90 579 105 105 1,797 3,052 2010 54,612,442 54,612,442 31 651 344 344 127 127 104 104 2,420 2009 69,228,416 69,228,416 23 68 575 624 102 102 535 535 2008 27,880,441 27,880,441 tor (plants) (plants) (plants) (plants) (hectares) (hectares) (hectares) (hectares) Indica - Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication equivalents) equivalents) equivalents) equivalents) equivalents) equivalents) equivalents) equivalents) plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Country Latvia Lao PDR Kyrgyzstan Kazakhstan Kazakhstan Kazakhstan Japan Iran (Islamic Republic Iran (Islamic Republic of) Iran (Islamic Republic Iran (Islamic Republic of) India Italy Italy India Hungary Guatemala Guatemala Guatemala Guatemala

38 Annex - Opium/heroin 1 2,605 2018 0.4 0.2 169 3,533 4,789 4,789 10,040 29,692 20,187 20,187 2017 1,470 7,561 9,771 9,771 1,023 1,023 22,437 16,401 16,401 2016 605 8,013 8,013 4,576 4,576 13,450 26,426 17,948 17,948 2015 1 9.4 9.4 1,010 5,976 5,976 15,188 21,644 14,812 14,812 2014 6 6 568 1.6 1.6 4,650 4,650 25,369 12,288 14,662 10,209 10,209 2013 592 9,572 9,572 11,255 23,718 15,726 2012 4 164 164 7,058 1,053 32,413 16,389 10,101 10,101 2011 21 68 14 8,267 3,855 3,855 9,335 9,335 15,491 2010 9 32 35 21 16 105 4,087 7,964 7,964 14,753 25,550 25,550 2009 0 23 21 45 4,820 7,263 7,263 13,095 81,675 81,675 2008 tor (plants) (plants) (hectares) (hectares) (hectares) (hectares) (hectares) (hectares) (hectares) (hectares) Indica - Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication equivalents) equivalents) equivalents) equivalents) equivalents) equivalents) plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Country Republic of Moldova Peru Republic of Korea Poland Portugal Republic of Korea Oman Pakistan Nepal New Zealand Pakistan Myanmar Mexico Mexico Lithuania Lebanon

39 EXECUTIVE SUMMARY 2019 REPORT 2018 DRUG 0.3 0.5 2.4 188 375 375 2017 WORLD 0.3 0.8 863 319 164 270 270 0.02 0.02 2016 18 48 0.3 0.6 205 930 930 1,043 1,043 2015 19 0.3 1.1 406 645 384 384 219 219 17.8 17.8 1,438 1,438 2014 1 25 39 0.9 30 336 264 103 1.2 1.2 2,216 2,216 2013 22,800,000 35 0.6 10 330 205 7.4 7.4 5.8 5.8 5,400 3,196 3,196 474,000 2012 1 38 13 1.4 413 208 4.2 4.2 4,273 4,273 2011 13 896 278 436 4,162 4,162 2,575 2,575 2010 1,185,118 31 3.3 687 201 2,807 2,807 26,075 26,075 2009 99 28 79 138 285 2,799 2,799 164,000 164,000 2008 tor (plants) (plants) (plants) (hectares) (hectares) (hectares) (hectares) (hectares) Indica - Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication Eradication equivalents) equivalents) equivalents) equivalents) equivalents) equivalents) plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg plants (in kg Seizure poppy poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure poppy Seizure Seizure poppy poppy Seizure Seizure poppy poppy Seizure Country Viet Nam Ukraine Uzbekistan Uzbekistan Tajikistan Thailand Ukraine Ukraine Spain State of Palestine Russian Federation Russian Federation Republic of Moldova Russian Federation the United States of America. Source: United Nations Office on Drugs and Crime annual report questionnaire, government reports, reports of regional bodies, and international narcotics control strategy reports of of strategy reports bodies, and international control of regional narcotics government reports questionnaire, reports, on Drugs and Crime annual report United Nations Office Source:

40 Annex - Opium/heroin 1

2018 14 kg) of 14 kg) of 487-737 487-737 6,265-6,565 6,265-6,565 1,225-1,525 1,225-1,525 7,790 7,790 2003). Starting from 2014, 2003). Starting from 2014, 2017 12.9 kg (range: 9 ‒ 692-1042 692-1042 9,020-9,320 9,020-9,320 1,100-1,400 1,100-1,400 10,420 10,420 31), and United Nations Office on 31), and United Nations Office on 2016 388 388 3,670 3,670 2,510 2,510 6,180 6,180 2015 327 327 3,411 3,411 1,360 1,360 4,771 4,771 2014 542 542 5,273 5,273 2,450 2,450 7,723 7,723 2012, down from 15 per cent over the period 2000 ‒ 2013 555 555 4,210 4,210 2,600 2,600 6,810 6,810 2012 377 377 2,981 2,981 1,850 1,850 4,831 4,831 2011 467 467 3,583 3,583 3,400 3,400 6,983 6,983 2010 383 383 3,002 3,002 1,728 1,728 4,730 4,730 2009 427 427 3,273 3,273 1,680 1,680 4,953 4,953 2008 600 600 4,481 4,481 2,360 2,360 6,841 6,841 2007 686 686 5,012 5,012 3,078 3,078 8,091 8,091

Total potential potential Total manufacture heroin processed into heroin processed Potential opium Potential opium Potential opium not Potential opium not into heroin processed Total potential potential Total opium production heroin “cooks”, documented by the German Bundeskriminalamt in Afghanistan in 2003 (published in Bulletin on Narcotics, vol. LVII, Nos. 1 and 2, 2005, pp. 11 ‒ heroin “cooks”, documented by the German Bundeskriminalamt in Afghanistan 2003 (published Bulletin on Narcotics, vol. LVII, ven year; it does not take into account changes in opium Notes: The calculation shows the potential amount of heroin that could have been manufactured out opium produced in a gi ven year; it does not take into account changes Afghanistan and Myanmar are the only countries for which proportion of potential opium inventories, which may add to or reduce the amount of heroin entering market in that year. djusted when improved information becomes available. Figures in For countries other than Afghanistan, a “traditional” conversion ratio of opium to heroin 10:1 is used. The ratios will be djusted when improved information becomes available. Figures in italics are preliminary and may be revised when updated information becomes available. Drugs and Crime (UNODC) studies on the morphine content of Afghan opium (12.3 per cent over period 2010 ‒ May 2018). East Asia (TOCTA EAP report, 2013) and considering the EAP report, 2013) and considering the factor of 10:1. The unprocessed opium in Myanmar was estimated to be 125 tons 2018, based on the total East Asia (TOCTA production not converted into heroin within the country is estimated. For all other countries, for the purposes of this table, it assumed that opium produced converted into heroin. ratio into heroin. The first parameter’s estimate is based on consumption data in Afghanistan and neighbouring countries. For the second parameter, from 2005 to 2013, a conversion ratio of from 2005 to 2013, a conversion ratio of estimate is based on consumption data in Afghanistan and neighbouring countries. For the second parameter, ratio into heroin. The first parameter’s relative cultivation levels of Lao PDR and Myanmar. For further information, please refer to the Methodology chapter (section 4.3) of Myanmar Opium Survey 2018 (UNODC, January 2019). relative cultivation levels of Lao PDR and Myanmar. or taking purity into account. The revised approach uses a ratio a different approach to the conversion was adopted, reflecting updated information on morphine content and method f or taking purity into account. The revised uses ratio opium to morphine/heroin of 7:1 was used, based on interviews conducted with Afghan morphine/heroin “cooks”, on an actual heroin production exercise by two (illiterate) of 18.5 kg opium for 1 100 per cent pure heroin base (see Afghanistan Opium Survey 2014, UNODC, November 2014). This translates into a ratio of 9.2 ‒ opium for 1 kg of export-quality heroin of 50–70 per cent purity. For more details, see “Afghanistan Opium Survey 2017 – Challenges to sustainable development, peace and security” (UNODC, opium for 1 kg of export-quality heroin 50–70 per cent purity. Global manufacture of heroin from global illicit opium production, 2007–2018 (tons) global illicit opium production, from of heroin Global manufacture nsumed as raw opium in the region; and (b) the conversion The amount of heroin produced from Afghan opium is calculated using two parameters that may change: (a) the amounts co nsumed as raw in region; and (b) conversion from the total opium production and using a conversion The amount of heroin produced in Myanmar 2018 was calculated by subtracting the estimated unprocessed opium for consumption from total production and using a conversion

41 EXECUTIVE SUMMARY 2019 REPORT

2017 2017 10,100 .. 25,784 0 52,001 7,237 245,400 245,400 49,900 49,900 24,500 24,500 171,000 171,000 DRUG 2016 20,896 .. 30,150 0 17,642 6,577 WORLD 2016 213,000 213,000 43,900 43,900 23,100 23,100 146,000 146,000 2015 45,266 .. 35,868 36,494 13,473 11,020 2015 156,500 156,500 40,300 20,200 96,000 2014 15,874 .. 31,205 55,532 11,703 11,144 2014 132,300 132,300 42,900 20,400 69,000 2013 41,996 .. 23,785 47,052 22,121 11,407 2013 120,800 49,800 23,000 48,000 2012 122,656 .. 14,171 100,549 30,456 11,044 2012 2011 133,700 133,700 60,400 25,300 48,000 55,030 14 10,290 103,302 35,201 10,509 d 2011 2010 3,870 3 12,033 101,940 43,804 8,200 62,500 27,200 64,000 64,400 155,600 2009 2010 57,765 6 10,025 104,772 60,565 6,341 31,000 62,000 61,200 154,200 154,200 2008 152,000 12 10,143 133,496 96,003 5,484 2009 30,900 73,000 59,900 163,800 163,800 plants Unit hectare hectare hectare hectare hectare 2008

30,500 81,000 56,100 167,600 167,600 manual manual manual manual spraying 2007 Method of 28,900 99,000 53,700 181,600 181,600 eradication a

b c Figures represent the area under coca cultivation as interpreted on satellite imagery. The global coca cultivation figure was calculated with the "area as interpreted on satellite imagery" for Peru in 2011. Net area on 31 December. Net area on 31 December, deducting fields eradicated after satellite imagery was taken. Net area on 31 December, Ecuador Peru Colombia Bolivia Bolivia (Plurinational State of) (Plurinational State of) (Plurinational State of) Bolivia Bolivia Total Peru Colombia Peru b Note: Different area concepts and their effect on comparability were presented in the World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1) (p. 41-42). Efforts to improve the Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1) (p. 41-42). Efforts to improve the Note: Different area concepts and their effect on comparability were presented in the World including repeated Note: The totals for Bolivia (Plurinational State of) and Peru include voluntary and forced eradication. Reported eradication refers to the sum of all areas eradicated in a year, monitoring system supported by UNODC. Peru: national illicit crop monitoring system supported by UNODC. monitoring system supported by UNODC. Peru: national illicit crop Reported eradication of coca bush, 2007–2017 Colombia. The estimate presented for the Plurinational State of Bolivia represents area under coca cultivation as interpret ed on satellite imagery. a e of 31 December was estimated for Peru, in addition to comparability of estimates between countries continue; since 2011 the net area under coca bush cultivation on reference dat e 31 December was estimated for Peru, in addition to dots indicate that data are not available. eradication of the same fields. Two c d Sources: Plurinational State of Bolivia: national illicit crop monitoring system supported by the United Nations Office on Drugs and Crime (UNODC). Colombia: national illicit crop on Drugs and Crime (UNODC). Colombia: national illicit crop monitoring system supported by the United Nations Office Plurinational State of Bolivia: national illicit crop Sources: and government questionnaire reports. on Drugs and Crime annual report United Nations Office Source: Global illicit cultivation of coca bush, 2007–2017 (hectares) Coca/cocaine

42 Annex - Coca/cocaine 1 2008) 2008) 2012 2012 2017 1,743 1,743 1,976 .. 1,379 .. 2015 (for 2015 (for 2016 1,378 1,378 1,586 .. 1,053 .. 2015 936 936 1,124 .. 646 .. 2014 746 746 943 .. 442 .. 2013 662 662 902 .. 290 .. 2012 738 738 997 .. 333 .. 2011 815 815 1,090 .. 384 .. 2010 862 862 1,134 .. 424 .. 2009 920 920 1,188 .. 488 488 .. 2008 886 886 1,143 113 471 471 302 2007 1,077 1,077 1,317 104 104 683 683 290 290

a a

account. Conversion of areas under coca cultivation into leaf and then cocaine hydrochloride, taking yields, amounts l eaf used for licit purposes laboratory efficiency into

Bolivia Bolivia (Plurinational State of) Total based on “new” based on “new” Total conversion ratios Colombia Peru conversion ratios Total based on “old” based on “old” Total based on "old" and "new" conversion ratios have been revised to rectify minor inaccuracies in data processing. have been revised in order to ensure a consistent implementation of revisions to the methodology, affecting the way coca production is calculated, for entire time series 2005 ‒ have been revised in order to ensure a consistent implementation of revisions the methodology, dots indicate that data are not available. Information on estimation methodologies and definitions can be found in the online methodology section of Figures in italics are subject to revision. Two vel of cocaine production can be provided. Notes: Owing to a lack of updated conversion factors in Bolivia (Plurinational State of) and Peru, no final estimates the le vel cocaine production can be provided. to cocaine conversion ratio from scientific studies by the Drug Enforcement Administration. Detailed information on the ongoing revision of conversion ratios and cocaine laboratory of conversion ratios and cocaine laboratory Administration. Detailed information on the ongoing revision scientific studies by the Drug Enforcement to cocaine conversion ratio from Potential manufacture of 100 per cent pure cocaine, 2007–2017 (tons) of 100 per cent pure Potential manufacture With respect to data published in the World Drug Report 2016 (United Nations publication, Sales No. E.16.XI.7), the following amendments have been made: (a) data for Colombia (2005 ‒ With respect to data published in the World a studies by the Drug Enforcement Administration of the United States of America (Chapare). Colombia: UNODC/Government Administration of the United States America (Chapare). of Colombia. Peru: own calculations based on coca leaf studies by the Drug Enforcement details, see Colombia Coca Cultivation Survey Report 2014 (UNODC, 2015) and Colombia Survey of territories affected by illicit crops 2015, Annex 3 (UNODC 2016)); (b) totals for 2009 ‒ the World Drug Report 2019. Report Drug World the Sources: Plurinational State of Bolivia: own calculations based on coca leaf yield surveys by the United Nations Office on Drugs and Crime (UNODC) (Yungas de La Paz) and scientific de La Paz) and scientific on Drugs and Crime (UNODC) (Yungas Plurinational State of Bolivia: own calculations based on coca leaf yield surveys by the United Nations Office Sources: Drug Report 2010 (United Nations publication, Sales No. E.10.XI.13), p. 249. is available in the World efficiency

43 EXECUTIVE SUMMARY 2019 35 59 93 32 28 21 20

151 195 948 408 433 500 500 REPORT 1,175 1,164 2,283 1,945 1,021 5,205 5,205 Sites Sites DRUG eradicated 848 757 4,885 8,469 2,547 WORLD 2,522 2,522 7,766 7,766 50,897 47,104 39,967 35,988 35,012 39,848 17,270 14,889 31,431 22,257 31,266 78,310 66,927 66,927 415,728 345,518 336,791 2,536,288 2,536,288 Plants Plants eradicated 1,400 1,400 263.96 (tons) Production Production 0.25 0.00 0.00 0.00 0.00 0.00 0.00 area (ha) area Harvestable Harvestable 3.00 1.00 0.50 0.50

14.60 23.95 17.50 125.90 123.80 (ha) Area Area eradicated eradicated a a a a a a a

0.25 3.00 1.00 0.50 0.50 23.95 17.50 10,000 10,000 (ha) Area Area cultivated cultivated indoors indoors indoors indoors indoors indoors indoors oudoors oudoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors indoors Outdoors/ Outdoors/ herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb resin resin Product Country Bolivia (Plurinational State of) Belize Belgium Belgium Belgium Belgium Belarus Belarus Belarus Belarus Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bahamas Azerbaijan Azerbaijan Azerbaijan Austria Australia Australia Australia Australia Armenia Armenia Albania Albania Algeria Albania Afghanistan Year 2016 2015 2017 2015 2017 2015 2017 2016 2017 2016 2016 2015 2014 2013 2012 2015 2013 2014 2017 2015 2017 2016 2017 2016 2017 2016 2017 2016 2014 2017 2012 Cannabis the period 2012–2017 and eradication, latest year available from Cannabis cultivation, production

44 Annex - Cannabis 1 8 1 5 2 1 34 65 97 22 53 52

105 229 305 215 201 264 202 604 2,740 2,408 Sites Sites eradicated 5 1 224 111 678 323 539 3,467 4,111 9,488 34,801 13,217 14,560 53,549 50,925 58,950 26,988 50,414 194,694 250,000 250,000 2,122,244 1,390,000 1,364,316 1,364,316 1,910,451 Plants Plants eradicated 0.21 10.00 37.77 (tons) Production Production 55 0.00 0.00 area (ha) area Harvestable Harvestable 6.00 0.25 9.80 0.02

17.59 60.00 44.01 39.00 14.00 173.71 135.00 117.51 1,680.00 (ha) Area Area eradicated eradicated a a

6.00 0.02 130.00 (ha) Area Area cultivated cultivated

indoors indoors indoors indoors indoors indoors indoors indoors indoors indoors/ indoors/ indoors/ outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors indoors Outdoors/ Outdoors/ herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb Product Country Ecuador Dominican Republic Denmark Denmark Denmark Czechia Czechia Czechia Czechia Côte d’Ivoire Côte d’Ivoire Costa Rica Costa Rica Costa Rica Costa Rica Colombia Colombia Chile China Chile Chile Chile Central African Republic Bulgaria Brazil Brazil Bulgaria Bosnia and Herzegovina Bosnia and Herzegovina Bosnia and Herzegovina Bosnia and Herzegovina Bolivia (Plurinational State of) Year 2016 2014 2017 2016 2015 2017 2016 2017 2016 2017 2016 2017 2016 2017 2016 2017 2016 2017 2016 2016 2017 2016 2017 2015 2017 2014 2015 2016 2017 2016 2017 2017

45 EXECUTIVE SUMMARY 2019 1 3 2 50 14 20 19 19 95 25 19 91 10

401 323 150 427 127 837 786 573 210 REPORT 1,161 Sites Sites DRUG eradicated 7 93 227 186 397 329 329 9,046 7,273 6,652 5,000 2,000 WORLD 9,136 9,136 56,125 85,226 24,253 24,253 16,554 16,554 19,498 39,151 27,409 209,510 738,020 158,592 135,925 419,700 419,700 6,687,376 3,000,000 6,033,345 6,033,345 3,138,298 3,138,298 Plants Plants eradicated 1.61 1,000.00 (tons) Production Production 0.00 0.00 0.00 1.00 0.00 10.60 430.50 area (ha) area Harvestable Harvestable 9.40 9.00 3.81 0.02 0.01

89.00 59.59 482.00 126.00 140.00 3,414.74 3,445.90 1,069.50 (ha) Area Area eradicated eradicated a a a a a

20.00 20.00 3.50 0.02 89.00 59.58 482.00 1,500.00 (ha) Area Area cultivated cultivated indoors indoors indoors indoors indoors indoors indoors indoors indoors indoors indoors indoors oudoors oudoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors indoors Outdoors/ Outdoors/ herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb/resin herb/resin Product Country Italy Italy Ireland Ireland Indonesia Indonesia India India Iceland China, Hong Kong SAR Honduras Hungary Hungary Honduras Honduras Guyana Greece Greece Greece Greece Guatemala Guatemala Germany France Germany Germany Germany El Salvador Georgia Georgia Eswatini Egypt Egypt Ecuador Year 2017 2017 2017 2016 2017 2016 2016 2017 2013 2016 2017 2016 2016 2016 2016 2015 2016 2017 2016 2017 2016 2017 2017 2014 2015 2017 2015 2016 2017 2017 2014 2017 2015 2017

46 Annex - Cannabis 1 3 4 8 7 6 15 34 35 46 91

607 382 202 639 5,538 5,856 4,000 1,134 38,432 34,523 Sites Sites eradicated 27 78 66 798 557 456 4,000 4,662 8,747 18,903 19,992 57,708 21,325 70,125 51,534 883,163 994,068 170,000 930,774 Plants Plants eradicated 714.06 713.00 6,574.1 5,032.0 35,702.90 35,652.83 (tons) Production Production 5.00 0.00 0.00 3,500.00 5,014.00 11,000.00 46,605.00 46,977.00 area (ha) area Harvestable Harvestable 9.00 0.10

10.00 11.00 18.00 12.30 395.00 523.00 5,478.42 4,193.34 4,000.00 (ha) Area Area eradicated eradicated a a

15.00 12.00 18.00 12.30 3,500.00 5,014.00 15,000.00 47,000.00 47,500.00 40,772.00 (ha) Area Area cultivated cultivated indoors indoors indoors indoors indoors indoors indoors indoors indoors indoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors indoors Outdoors/ Outdoors/ herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb resin resin plant plant Product Country New Zealand New Zealand Netherlands Netherlands Myanmar Morocco Morocco Morocco Malta Mexico Mexico Mongolia Morocco Morocco Morocco Lithuania Lithuania Lithuania Madagascar Madagascar Lebanon Lebanon Latvia Latvia Latvia Kyrgyzstan Latvia Kenya Kenya Kazakhstan Kazakhstan Jamaica Italy Italy Year 2016 2017 2017 2016 2014 2017 2016 2017 2013 2016 2017 2013 2016 2017 2016 2016 2017 2017 2015 2017 2015 2017 2016 2017 2017 2015 2016 2017 2016 2016 2017 2012 2014 2014

47 EXECUTIVE SUMMARY 2019 2 2 4 32 42 46 41 54 10 27 47 30 65 30

788 158 219 337 REPORT 1,143 1,990 1,403 Sites Sites DRUG eradicated 37 448 4,905 1,875 8,072 1,433 4,585 4,000 3,014 WORLD 22,910 78,633 19,559 200,548 257,236 146,755 221,035 104,725 4,671,387 1,429,749 5,656,266 24,635,153 36,550,000 Plants Plants eradicated 1.15 68.64 1,298.50 1,507.00 10,000.00 (tons) Production Production 0.00 0.00 0.00 0.00 41.00 area (ha) area Harvestable Harvestable 7.61 0.87 0.66 1.90 6.99 2.57 4.82 8.67 0.50 0.04 0.30

59.00 41.00 61.30 87.83 10.50 317.12 718.78 1,298.50 1,462.00 (ha) Area Area eradicated eradicated a a a a

0.15 0.15 7.61 0.50 10.50 100.00 100.00 1,298.50 (ha) Area Area cultivated cultivated

indoors indoors indoors indoors indoors indoors indoors indoors indoors indoors/ indoors/ indoors/ outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors indoors Outdoors/ Outdoors/ herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb resin plant plant Product Country Russian Federation Russian Federation Russian Federation Romania Romania Republic of Moldova Romania Republic of Moldova Republic of Moldova Romania Republic of Korea Portugal Poland Poland Poland Poland Philippines Philippines Peru Peru Paraguay Panama Panama Paraguay Norway Paraguay Paraguay Nigeria Nigeria Nicaragua New Zealand New Zealand Year 2016 2017 2016 2017 2016 2014 2017 2017 2014 2016 2013 2017 2017 2016 2017 2016 2017 2016 2017 2016 2016 2013 2013 2016 2015 2017 2016 2017 2016 2014 2016 2017

48 Annex - Cannabis 1 5 1 3 58 44 83 56 44 78 31

618 586 100 108 118 1,399 5,513 4,062 1,865 5,379 Sites Sites eradicated 661 385 190 1,926 5,100 1,844 9,223 2,299 11,386 71,750 10,000 10,259 303,654 406,125 375,925 244,772 135,074 4,940,596 3,078,418 4,600,000 2,180,121 Plants Plants eradicated 7.50 0.05 30.07 182.00 345.00 205.00 (tons) Production Production 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 62.00 190.00 area (ha) area Harvestable Harvestable 1.00 0.20 0.20 0.31 1.00 8.00 2.00

91.00 88.00 166.90 159.00 1,250.00 (ha) Area Area eradicated eradicated a a a a a a a a

0.20 0.20 1.00 8.00 2.00 150.00 190.00 91.00 159.00 1,250.00 (ha) Area Area cultivated cultivated indoors indoors indoors indoors indoors indoors indoors indoors indoors indoors indoors oudoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors outdoors indoors Outdoors/ Outdoors/ herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb herb Product Country Viet Nam Uzbekistan Uzbekistan Uruguay United States of America United States of America Uruguay United States of America United States of America Ukraine Uganda Ukraine Trinidad and Tobago Trinidad Thailand Switzerland Switzerland Tajikistan Sweden Sweden Sudan Sweden Sudan Spain Spain Slovenia Slovenia Slovenia Slovakia Slovakia Sierra Leone Serbia Russian Federation Area identified by the authorities for eradication.

Year 2015 2017 2016 2017 2016 2017 2016 2017 2016 2017 2012 2016 2015 2016 2016 2017 2012 2017 2015 2017 2014 2014 2015 2015 2017 2014 2014 2017 2016 2013 2015 2017 Source: United Nations Office on Drugs and Crime annual report questionnaire, government reports and and international narcotics control strategy reports of the United States of of the United States strategy reports government and international control questionnaire, reports narcotics on Drugs and Crime annual report United Nations Office Source: America. a

GLOSSARY amphetamine-type stimulants — a group of sub- problem drug users — people who engage in the stances composed of synthetic stimulants controlled high-risk consumption of drugs. For example, under the Convention on Psychotropic Substances people who inject drugs, people who use drugs on of 1971 and from the group of substances called a daily basis and/or people diagnosed with drug use amphetamines, which includes amphetamine, meth- disorders (harmful use or drug dependence), based amphetamine, methcathinone and the on clinical criteria as contained in the Diagnostic “ecstasy”-group substances (3,4-methylenedioxym- and Statistical Manual of Mental Disorders (fifth edi- ethamphetamine (MDMA) and its analogues). tion) of the American Psychiatric Association, or amphetamines — a group of amphetamine-type the International Classification of Diseases and Related stimulants that includes amphetamine and Health Problems (tenth revision) of WHO. methamphetamine. people who suffer from drug use disorders/people with annual prevalence — the total number of people of drug use disorders — a subset of people who use a given age range who have used a given drug at drugs. Harmful use of substances and dependence least once in the past year, divided by the number are features of drug use disorders. People with drug of people of the given age range, and expressed as a use disorders need treatment, health and social care percentage. and rehabilitation. coca paste (or coca base) — an extract of the leaves harmful use of substances — defined in the Interna- of the coca bush. Purification of coca paste yields tional Statistical Classification of Diseases and Related cocaine (base and hydrochloride). Health Problems (tenth revision) as a pattern of use that causes damage to physical or mental health. “crack” cocaine — cocaine base obtained from cocaine hydrochloride through conversion processes dependence — defined in the International Statistical to make it suitable for smoking. Classification of Diseases and Related Health Problems (tenth revision) as a cluster of physiological, behav- cocaine salt — cocaine hydrochloride. ioural and cognitive phenomena that develop after drug use — use of controlled psychoactive substances repeated substance use and that typically include a for non-medical and non-scientific purposes, unless strong desire to take the drug, difficulties in control- otherwise specified. ling its use, persisting in its use despite harmful consequences, a higher priority given to drug use fentanyls — fentanyl and its analogues. than to other activities and obligations, increased new psychoactive substances — substances of abuse, tolerance, and sometimes a physical withdrawal state. either in a pure form or a preparation, that are not substance or drug use disorders — referred to in the controlled under the Single Convention on Narcotic Diagnostic and Statistical Manual of Mental Disorders Drugs of 1961 or the 1971 Convention, but that (fifth edition) as patterns of symptoms resulting may pose a public health threat. In this context, the from the repeated use of a substance despite expe- term “new” does not necessarily refer to new inven- riencing problems or impairment in daily life as a tions but to substances that have recently become result of using substances. Depending on the available. number of symptoms identified, substance use dis- opiates — a subset of opioids comprising the various order may be mild, moderate or severe. products derived from the opium poppy plant, prevention of drug use and treatment of drug use dis- including opium, morphine and heroin. orders — the aim of “prevention of drug use” is to opioids — a generic term that refers both to opiates prevent or delay the initiation of drug use, as well and their synthetic analogues (mainly prescription as the transition to drug use disorders. Once a person or pharmaceutical opioids) and compounds synthe- develops a drug use disorder, treatment, care and sized in the body. rehabilitation are needed

REGIONAL GROUPINGS

The World Drug Report uses a number of regional • East and South-East Asia: Brunei Darussalam, and subregional designations. These are not official Cambodia, China, Democratic People’s Republic designations, and are defined as follows: of Korea, Indonesia, Japan, Lao People’s Democratic Republic, Malaysia, Mongolia, • East Africa: Burundi, Comoros, Djibouti, Eritrea, Myanmar, Philippines, Republic of Korea, Ethiopia, Kenya, Madagascar, Mauritius, Rwanda, Singapore, Thailand, Timor-Leste, Viet Nam, Seychelles, Somalia, South Sudan, Uganda, Hong Kong, China, Macao, China, and Taiwan United Republic of Tanzania and Mayotte Province of China • North Africa: Algeria, Egypt, Libya, Morocco, • South-West Asia: Afghanistan, Iran (Islamic Sudan and Tunisia Republic of) and Pakistan • Southern Africa: Angola, Botswana, Eswatini, • Near and Middle East: Bahrain, Iraq, Israel, Lesotho, Malawi, Mozambique, Namibia, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi South Africa, Zambia, Zimbabwe and Reunion Arabia, State of Palestine, Syrian Arab Republic, • West and Central Africa: Benin, Burkina United Arab Emirates and Yemen Faso, Cabo Verde, Cameroon, Central African • South Asia: Bangladesh, Bhutan, India, Maldives, Republic, Chad, Congo, Côte d’Ivoire, Nepal and Sri Lanka Democratic Republic of the Congo, Equatorial • Guinea, Gabon, Gambia, Ghana, Guinea, Eastern Europe: Belarus, Republic of Moldova, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Russian Federation and Ukraine Nigeria, Sao Tome and Principe, Senegal, Sierra • South-Eastern Europe: Albania, Bosnia and Leone, Togo and Saint Helena Herzegovina, Bulgaria, Croatia, Montenegro, North Macedonia, Romania, Serbia, Turkey and • Caribbean: Antigua and Barbuda, Bahamas, Kosovo Barbados, Cuba, Dominica, Dominican Republic, Grenada, Haiti, Jamaica, Saint Kitts and Nevis, • Western and Central Europe: Andorra, Austria, Saint Lucia, Saint Vincent and the Grenadines, Belgium, Cyprus, Czechia, Denmark, Estonia, Trinidad and Tobago, Anguilla, Aruba, Bonaire, Finland, France, Germany, Greece, Hungary, Netherlands, British Virgin Islands, Cayman Iceland, Ireland, Italy, Latvia, Liechtenstein, Islands, Curaçao, Guadeloupe, Martinique, Lithuania, Luxembourg, Malta, Monaco, Montserrat, Puerto Rico, Saba, Netherlands, Sint Netherlands, Norway, Poland, Portugal, San Eustatius, Netherlands, Sint Maarten, Turks and Marino, Slovakia, Slovenia, Spain, Sweden, Caicos Islands and United States Virgin Islands Switzerland, United Kingdom of Great Britain and Northern Ireland, Faroe Islands, Gibraltar • Central America: Belize, Costa Rica, El Salvador, and Holy See Guatemala, Honduras, Nicaragua and Panama Oceania (comprising four subregions): • North America: Canada, Mexico, United States of America, Bermuda, Greenland and Saint-Pierre • Australia and New Zealand: Australia and and Miquelon New Zealand • South America: Argentina, Bolivia (Plurinational • Polynesia: Cook Islands, Niue, Samoa, Tonga, State of), Brazil, Chile, Colombia, Ecuador, Tuvalu, French Polynesia, Tokelau and Wallis and Guyana, Paraguay, Peru, Suriname, Uruguay, Futuna Islands Venezuela (Bolivarian Republic of) and Falkland • Melanesia: Fiji, Papua New Guinea, Solomon Islands (Malvinas) Islands, Vanuatu and New Caledonia • Central Asia and Transcaucasia: Armenia, • Micronesia: Kiribati, Marshall Islands, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Micronesia (Federated States of), Nauru, Palau, Tajikistan, Turkmenistan and Uzbekistan Guam and Northern Mariana Islands

53 Research

Vienna International Centre, PO Box 500, 1400 Vienna, Austria Tel: +(43) (1) 26060-0, Fax: +(43) (1) 26060-5866, www.unodc.org

The World Drug Report 2019 is again presented in five separate parts that divide the wealth of information and analysis contained in the report into individual reader-friendly booklets in which drugs are grouped by their psychopharmacological effect for the first time in the report’s history.

Booklet 1 provides a summary of the four subsequent booklets by reviewing their key findings and highlighting policy implications based on their conclusions. Booklet 2 contains a global overview ofEXECUTIVE the latest estimates of SUMMARYand trends in the supply, use and health consequences of drugs. Booklet 3 looks at recent trends in the marketConclusions for depressants and (including policy opioids, implications sedatives, tranquillizers 1and hypnotics), while Booklet 4 deals with recent trends in the market for stimulants (including cocaine, amphetamine-type stimulants and new psychoactive substances). Booklet 5 contains a review of recent trends in the market for cannabis and for hallucinogens. The section on cannabis also includes a review of the latest developments in the jurisdictions that have adopted measures allowing the non-medical use of cannabis.

As in previous years, the World Drug Report 2019 is aimed at improving the understanding of the world drug problem and contributing towards fostering greater international cooperation for countering its impact on health, governance and security.

The statistical annex is published on the UNODC website: https:// 2019www.unodc.org/wdr2019

ISBN 978-92-1-148314-7